Because of the large amount of prostate cancer screening there has been a major shift in initial staging in prostate cancer  in western countries, with the incidence of metastases at diagnosis decreasing from over 50% in the 1970s to currently less than 10%.  Despite this very significant drop in late stage diagnoses prostate cancer is still the second cause of cancer death in men!

Researchers used two monthly curated databases of patients with castration-resistant prostate cancer  to describe the natural history of patients dying of  prostate cancer in the modern era.

They studied 190 men with metastatic castrate resistant prostate cancer treated from 2008 to 2011. They characterized the patients who eventually died from  prostate cancer (n=113 0r 61%) during the study time period.

Of the 113 men who died of  prostate cancer sixty-three men (56%) had detectable metastases at diagnosis: 67%, 11% and 43% had bone, visceral and lymph node metastases, respectively.

Among the men with with localized prostate cancer  at diagnosis (n=50, 44%), 46% had T stage greater than 3 and 38% had a Gleason score greater than 8. Overall, 64% of men were classified as having a high-risk prostate cancer. Only 26% who died from prostate cancer had a Gleason score less than or equal to 6.

Median overall survival was 8.8 years.

Using these findings as a guideline we find that approximately half of the men who die from  prostate cancer will have had a