prognosis, but it does increase the risk of dying younger from other causes, such as cardiovascular disease. Keeping other disease states under control, as much as possible, and maintaining general health through exercise and proper diet make a lot of sense.
Pain Men with HRPC and different pain levels tend to have different prognoses. The worse the pain caused by the cancer itself, the worse the prognosis or the more serious the situation. This makes sense because tumors that have grown large enough to cause pain are more troubling than smaller tumors not causing pain. Pain caused by other chronic conditions, such as arthritis, does not play a role in this consideration.
Performance Status Performance status is a scale that attempts to quantify the general well-being or quality of life of a patient. Healthcare professionals use the scale to determine whether someone should receive chemotherapy treatment, whether a dosage change is needed, or if therapy should even be continued for a particular patient. Two commonly used scales are the ECOG (Eastern Cooperative Oncology Group, one of the largest clinical cancer research organizations in the United States) test and the Karnofsky Performance Status test (named for Dr. David A. Karnofsky). A brief description of each follows. Overall, a poor performance status indicates a worse prognosis as compared to someone with a better performance status.
ECOG Performance Status
Numerous clinical trials require an ECOG performance status of 0 to 2 in order to be allowed to participate in clinical trials. Scores of 3 or 4 usually do not receive chemotherapy because the possibility of benefit is outweighed by the potential of negative side effects (of course, there are exceptions).
0 Asymptomatic (fully active, no restrictions)
1 Symptomatic and fully able to walk (can perform light work, such as household or office tasks, but cannot do strenuous activity)
2 Symptomatic and spends less than 50 percent of time in bed (can walk and provide self-care, but unable to do work activities)
3 Symptomatic and spends more than 50 percent of time in bed or chair (not bedbound, capable of limited self-care)
4 Bedbound (cannot provide for self-care, completely confined to bed or chair)
Karnofsky Performance Status
Can be expressed as a range (90–100) or a specific number (92).
100 Normal, no complaints or signs of disease
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.
