From the Guidelines
The survival rate for metastatic prostate cancer has improved significantly in recent years, with a 5-year relative survival rate of approximately 30-35%. This means about one-third of men diagnosed with metastatic prostate cancer will survive at least 5 years after diagnosis. However, individual outcomes vary widely based on several factors including the patient's age, overall health, extent of metastasis, PSA levels, Gleason score, and response to treatment.
Key Factors Influencing Survival
- Patient's age
- Overall health
- Extent of metastasis
- PSA levels
- Gleason score
- Response to treatment Modern treatment approaches have extended median survival to about 3-4 years for many patients.
Treatment Approaches
- Androgen deprivation therapy (ADT) with medications like leuprolide (Lupron), goserelin (Zoladex), or degarelix (Firmagon)
- Newer hormonal agents such as abiraterone (Zytiga) with prednisone, enzalutamide (Xtandi), apalutamide (Erleada), or darolutamide (Nubeqa)
- Chemotherapy with docetaxel may be added upfront for high-volume disease, as supported by studies such as CHAARTED and STAMPEDE 1
- Treating the primary tumor with radiation may improve outcomes for patients with limited metastatic disease Regular monitoring of PSA levels, imaging studies, and symptom assessment is essential to evaluate treatment response and adjust therapy as needed, as emphasized in guidelines such as the NCCN clinical practice guidelines in oncology 1. While metastatic prostate cancer remains incurable in most cases, many men can maintain good quality of life for extended periods with appropriate treatment. The most recent and highest quality study, such as the 2019 NCCN clinical practice guidelines in oncology 1, provides the best evidence for guiding treatment decisions.
From the FDA Drug Label
The median Survival, months (95% CI) 18.4 (17.3, NR) The median Survival, months (95% CI) 13. 6 (11.3,15.8) Number of Deaths (%) 308 (38.5) Number of Deaths (%) 212 (53.1)
The survival rate of metastatic prostate cancer patients treated with enzalutamide is approximately 61.5% at the median survival time of 18.4 months, compared to 46.9% for placebo-treated patients at the median survival time of 13.6 months 2.
- Key points:
- Median survival time: 18.4 months for enzalutamide-treated patients, 13.6 months for placebo-treated patients
- Percentage of deaths: 38.5% for enzalutamide-treated patients, 53.1% for placebo-treated patients
- Hazard Ratio (95% CI): 0.63 (0.53,0.75) favors enzalutamide 2
From the Research
Survival Rate of Metastatic Prostate Cancer
- The survival rate of metastatic prostate cancer has improved with the introduction of new therapeutic agents, including abiraterone acetate, enzalutamide, cabazitaxel, radium-223, and sipuleucel-T, which have been shown to improve overall survival 3.
- The addition of docetaxel chemotherapy or abiraterone acetate to androgen deprivation therapy has been found to significantly increase overall survival in patients with de novo castration-sensitive metastatic prostate cancer 3, 4.
- A systematic review and meta-analysis found that second-line agents, such as enzalutamide, abiraterone acetate, and cabazitaxel, can improve overall survival in patients with metastatic castration-resistant prostate cancer progressing after docetaxel, with significant overall survival advantages of 4.8 months, 4.6 months, and 2.4 months, respectively 5.
- The choice of treatment sequencing is crucial, and clinicians must consider the best treatment sequence for each patient, taking into account their comorbidities and preferences 6.
Treatment Options
- Treatment options for metastatic prostate cancer include androgen deprivation therapy, chemotherapy, new hormonal therapies, and immunotherapy 4.
- Docetaxel rechallenge may be an effective option for patients who initially responded to docetaxel and maintained a progression-free interval exceeding 6 months 7.
- The use of abiraterone acetate, enzalutamide, and other agents targeting the androgen axis has been found to significantly prolong radiographic progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer 5.
Future Directions
- Further investigation is warranted to evaluate the benefit of combination or sequential administration of these agents and to assess the impact of relevant toxic effects observed in a limited number of patients 5.
- Emerging fields include the identification of new subtypes with molecular characterization and new therapeutic targets, which may lead to further improvements in the management of metastatic prostate cancer 4.