90 Normal activity, few symptoms or signs of disease
80 Normal activity, some symptoms or signs of disease
70 Caring for self, not capable of normal activity or work
60 Needs some help, can take care of personal requirements
50 Needs help often, requires frequent medical care
40 Disabled, needs special help and care
30 Severely disabled, hospital admission indicated but no danger of death
20 Very ill, urgently needing admission, needs supportive measures of treatment
10 Rapidly progressive
Previous Response To Treatment(s) Response to previous HRPC treatments is a good indicator of prognosis or the aggressiveness of your tumor. For example, someone who responded well to several cycles of Taxotere chemotherapy has a better prognosis as compared to someone who responded for a short time or not at all. A patient who had a positive PSA response to several anti-androgens or secondary hormonal therapies has a better prognosis in general than someone who did not respond to any of them. Positive response to one drug treatment for HRPC is a good indicator that this same individual could respond favorably to other treatments.
Primary Tumor Site Status or Debulking This is a very controversial prognostic indicator. A number of opinions exist, and there are no clear answers as of this time, but it is a topic you may want to discuss with your doctor. In some other tumor types, such as colon and ovarian, a person with advanced cancer may have a better prognosis when the primary tumor or the location where the tumor initially began to grow is removed (debulked). It appears that removing the ovaries or part of the colon even though a patient has cancer that has spread far beyond these areas could still provide a benefit. How? Simply removing part of the primary tumor may make it less able to send out more cancer cells into the rest of the body or even communicate with other tumor cells in the body. Does this mean that men with HRPC should get their prostate removed or get radiation to the prostate again? While there is no definitive answer at this time, it may be worth discussing with your doctor.
Prostatic Acid Phosphatase (PAP) Historically, this blood test was used before the PSA test was invented to determine whether someone had prostate cancer. However, the prostatic acid phosphatase (PAP) number only increased to large values when the disease had already spread to different areas of the body, making early detection difficult. Some doctors still use this test once in a while to determine if HRPC is more extensive when they cannot find any tumors on the imaging devices. While this test may complement the prognostic value of the PSA in some rare situations, it does not tell the doctor more than what the other tests are showing for most patients.
PSA and PSA Kinetics Increasing PSA, rapidly increasing PSA, or a PSA that does not respond to a treatment could all be indicators of a worse prognosis, but keep in mind that there are exceptions to this rule. For example, Provenge treatment for HRPC does not necessarily reduce PSA levels, but it is associated with a greater survival rate. On the other hand, Taxotere chemotherapy tends to lower PSA or slow the rise in PSA in many men, and it is also associated with an improved survival for HRPC. There are also cases where very aggressive tumors don’t produce PSA, and where less aggressive tumors create a higher PSA. Considering both your PSA before treatment and location of the tumor in the body may provide some guidance.
PSA kinetics (doubling time, velocity) may also be useful. For example, the longer it takes for PSA to double after treatment, the more likely it is to be a favorable prognostic sign.
Race and Ethnicity may have an impact on prognosis for many reasons. Past studies have indicated that non-Caucasian men or minorities tend to have less access to healthcare or are more likely to have their treatment delayed. Improved education and healthcare access may resolve this factor in the future.
Staging of Cancer Staging is a system used to identify where a cancer is located and how far it has spread. The TNM staging system is the most common one used for prostate cancer. The acronym stands for primary tumor location (T), lymph nodes (N), and metastases (M). The tumor location is based on the results of a clinical examination, imaging tests, a biopsy, and blood tests. The node assessment is generally based on a clinical examination, imaging, or lymph node removal. The assessment of metastases utilizes clinical examination, imaging, specific bone or skeletal studies, and blood tests. Every prostate cancer should be given a T, N, and M assessment. An “x” or “0” score for the T, N, or M indicator usually means that either the location of the tumor cannot be determined currently (for example, Tx, Nx, or Mx), or there is no evidence of cancer in that area after evaluation (for example, T0, N0, or M0). Subcategories can be used to provide a more exact tumor location, but those subcategories won’t be covered here because in treating hormone-refractory cancer patients more emphasis is placed on the N and M staging. Not surprisingly, patients with a higher TNM stage have a worse prognosis than patients with a low TNM stage.
Testosterone Levels There is some preliminary research to suggest that a patient who had an abnormally low testosterone level before receiving an LHRH medication or surgical removal of the testicles could have a more aggressive prostate cancer, and that it may be more difficult to treat. This is preliminary, but it does make some sense that such a cancer would be able to grow with less testosterone available, making LHRH medication possibly less effective. In other words, some of these cells may have found a way to survive without much testosterone.
Time from Initial Treatment to CRPC Diagnosis If you were treated for localized prostate cancer, and then it rapidly progressed to become HRPC, this could indicate a more aggressive cancer. However, if you were diagnosed and treated for localized prostate cancer, and many years later the disease came back, and several years after that it became HRPC, it would imply a slow, steady cancer that may have a better prognosis.
PELVIC NODES
The pelvic lymph nodes are the first set of nodes in the human body where prostate cancer usually goes after growing beyond the prostate area.
Visceral Disease or Soft-Tissue Disease The literal meaning of visceral is “of the internal organs,” and this has come to mean cancer that has spread to locations apart from the prostate or bones, such as the liver, lungs, or other areas far from the prostate. Individuals who have visceral disease or cancer in multiple areas of the body and around the prostate tend to have a worse prognosis than those without disease in these areas. This is because the disease has advanced further. The situation is similar with what is called “soft-tissue disease,” where the cancer has gone to non-bony areas such as organs and/or regional or non-regional lymph nodes.
ABDOMINAL NODES
The abdominal pelvic lymph nodes are the second set of nodes where cancer may typically spread.
Volume or Amount of Cancer In general, the greater the amount of cancer in your body, the more aggressive the tumor, and the more serious the situation. For example, someone with cancer in the lymph nodes, in some organs, and in many bones tends to have a more aggressive cancer as compared to someone with just a few tumors located on a single bone. This is why working with your doctor to find the location of your tumor sites as early