Nine out of ten prostate cancer patients survive over five years compared to just one in three in 1976

More men are surviving prostate cancer than ever before thanks to huge strides in the prevention, detection and treatment of the disease.

40 years ago the outlook for a prostate cancer patient was vastly different from today. In 1976, a little over one in three men diagnosed with prostate cancer (35%) survived the disease over five years. Today, five-year survival rates for prostate cancer in Ireland have risen to nine in ten (90.6%).

However, more needs to be done to improve survival rates, particularly for men with metastatic prostate cancer, while also working on ways to improve the lives of men surviving the disease who often suffer a reduced quality of life.

For the past nine years the Irish Cancer Society has partnered with the Movember Foundation Ireland in investing in Irish research projects which aim to tackle these issues. The Movember community across Ireland is encouraged to again raise vital life-saving funds that will mean we can continue to invest in prostate cancer research, as well as advocacy and services.

According to Professor Ray McDermott, Consultant Medical Oncologist at Tallaght and St Vincent’s University Hospitals, Dublin and Clinical Director with prostate cancer research initiative iPROSPECT:

“The increase in survival rates for prostate cancer patients over recent decades is a testament to the work of research scientists in Ireland and across the globe. They have worked tirelessly in their battle against this disease and have saved countless lives.

“But survival rates only show one side of the journey a patient with this disease goes through. For survivors, their diagnosis and treatment often impacts their physical and mental wellbeing in ways men rarely speak openly about.

“Cancer research can address these impacts through studying survivors’ own experiences and finding ways to personalise their treatment and care. That is why investment in cancer research by the Irish Cancer Society and Movember – funded through you, the public – is so essential.”

Detection and diagnosis of prostate cancer

Prostate cancer is the most common cancer among Irish men, making up almost a third of all male cancers. The improved detection of prostate cancer means that now around 3,400 new cases of the disease are identified in Ireland each year.

Currently the first detection tests men will undergo are the PSA blood test – which measures a protein made by the prostate gland called prostate specific antigen – and a digital rectal examination. The FDA approved the PSA test for prostate cancer screening in 1994.

Since then PSA testing has increased 12-fold in Ireland, according to 2012 estimates. The use of widespread PSA testing here has contributed to a high measured incidence of prostate cancer in this country– in 2012 it was the fourth highest across Europe and the tenth highest globally.

But the PSA test can only indicate a prostate problem - it doesn’t specifically diagnose prostate cancer. PSA levels in the blood stream can rise if you have prostate cancer but it can rise for other reasons as well. Therefore, it is important that a PSA test is undertaken as part of an overall assessment of the likely presence of prostate cancer under clinician guidance and typically followed up with other more specific diagnostic tests.

Forty years ago if a man was suspected of having prostate cancer there was no specific clinical pathway they would follow. Today if the GP suspects a man may have prostate cancer they will refer them to a urology department, often through one of the Rapid Access Prostate Clinics. These special clinics, set up in the 2000’s, provide a fast, efficient service for men who need further tests done to assess for prostate cancer and are located in the eight designated cancer centres in Ireland.

At these clinics a man will typically have a Trans-rectal Ultrasound Scan followed by a Trans-rectal Needle Biopsy of the suspect prostate gland. From these biopsy results a diagnosis can then be made. Newer imaging techniques may also be employed to get more detailed information, if required. All of these techniques make obtaining a detailed diagnosis easier and less invasive than what would have been the case in 1976.

Treatment of prostate cancer

The treatment a prostate cancer patient receives depends on factors including how early the disease is detected, how the cancer cells look under the microscope and the patient’s health.
Surgery is still one of the most effective ways to treat prostate cancer that hasn’t spread, and it has become more sophisticated over the past 40 years. Initial surgical techniques removed the whole prostate but often damaged surrounding nerves and blood vessels, leading to impotence and incontinence issues. As a result, prostatectomy was not commonly performed.

In 1983 a modified surgical technique was developed that avoided damaging these vital nerves and blood vessels supporting normal working of the penis. This and the ultrasound-guided ‘biopsy’ diagnostic tool led to a huge increase in the number of successfully treated prostate cancer patients who were treated by prostatectomy.

Today, the removal of prostate cancer is more commonly done by keyhole surgery, which is far less traumatic for the body than open surgery. The main advantages of this less invasive surgery are that patients lose less blood, have less pain, spend less time in hospital and heal more quickly.

Other treatment options that have been developed and improved on since 1976 include radiotherapy, which can get rid of the cancer completely in more than 6 out of 10 men with early prostate cancer, hormone drug therapy, usually for stage three prostate cancers and for men with high PSA levels, and chemotherapy, for advanced prostate cancers.

The Future of prostate cancer

More personalised treatment

In Ireland, one in five men with prostate cancer will go on to develop metastatic prostate cancer – where their cancer has spread to other parts of the body – and succumb to their disease within ten years. In addition, approximately 200 Irish men per year are initially diagnosed with metastatic prostate cancer; of these less than one in five (19%) are expected to be alive after five years.

In 1976 there were very little treatment options available for men with metastatic prostate cancer. In recent years, several new treatments for metastatic prostate cancer have become available which have expanded the options for patients and their doctors. The challenge now lies in selecting the most appropriate treatment and determining the order in which they should be given.

We now know that not all cancer patients respond in the same way to these treatments. It’s important to find indicators of disease (known as markers), which can predict an individual patient’s response to treatment.

To support research in this area, the Irish Cancer Society and the Movember Foundation are supporting a research initiative that is looking at developing personalised treatment options for patients with advanced prostate cancer. Established in 2014, iPROSPECT (Irish Programme for Stratified Prostate Cancer Therapy) is investigating markers in blood or tissue that can predict each patient’s response to treatment and ultimately improve outcomes.

Caring for survivors

With more men surviving prostate cancer, their experiences of treatment and care are being given increasing importance among the research community.

The Irish Cancer Society and Movember Foundation support a research initiative which is assessing whether newly diagnosed Irish prostate cancer patients see big changes in their quality of life during and after treatment, and how their care compares internationally. IPCOR (Irish Prostate Cancer Outcomes Research) involves the National Cancer Registry Ireland, the HRB Clinical Research Facility in Galway, the National Cancer Control Programme and major academic medical institutions across the country represented by Molecular Medicine Ireland.

IPCOR is creating a national registry of newly diagnosed prostate cancer patients in Ireland. They are collecting clinical data on prostate cancer patients from the time of their diagnosis and throughout their treatments. The men also complete a quality of life questionnaire before their treatment begins and once a year thereafter. IPCOR’s goal is to identify ways to improve the care that men receive when diagnosed with prostate cancer and to increase their quality of life during their treatment.

Commenting on the work of the Irish Cancer Society in prostate cancer research, its Head of Research Dr Robert O’Connor said:

“To continue the ground-breaking work that has been completed in the last 40 years high quality research is essential. Funds raised through Movember make it possible for the Irish Cancer Society and the Movember Foundation Ireland to support vital, patient-focussed research like iPROSPECT and IPCOR so that we can continue the fight against prostate cancer in Ireland.”

To speak to a cancer nurse on any aspect of cancer contact our Cancer Nurseline on Freephone 1800 200 700, online, email cancernurseline@irishcancer.ie or drop into one of our 13 Daffodil Centres in hospitals nationwide.