Patients with locally advanced cancer are not usually curable, and a substantial fraction will eventually die of their tumor, although median survival may be as long as 5 years. If prostate cancer has spread to distant organs, current therapy will not cure it. Median survival is usually 1 to 3 years, and the majority of such patients will die of prostate cancer. Even in this group of patients, however, indolent clinical courses lasting for many years may be observed. In the majority of studies, flow cytometry has shown that nuclear DNA ploidy is an independent prognostic indicator for progression and for cause-specific survival in patients with pathologic stages C and D1.
Diploid tumors have a more favorable outcome than either tetraploid or aneuploid tumors.
The use of flow cytometry techniques, histogram analysis, and computer-assisted cell morphology as tools to determine prognosis will require standardization. Elevations of serum acid phosphatase are associated with poor prognosis in both localized and disseminated disease. PSA, an organ-specific marker with greater sensitivity and high specificity for prostate tissue, is often used as a tumor marker. However, a significant proportion of patients with elevated or rising PSA levels after surgery may remain clinically free of symptoms for extended periods of time. Therefore, biochemical evidence of failure on the basis of elevated or slowly rising PSA alone may not be sufficient to alter treatment.