Dear Dr. Roach: A few months ago, my husband was told that his prostate cancer has returned. He now has Stage 4 cancer. We asked all of his doctors (five of them!) what his prognosis is and received wildly varying answers — everything from two months to maybe 10 years. I understand that his prognosis depends on many factors, but is there a reason his physicians can’t give us a better idea? I also want very much to know if he will be in pain, and they won’t give me an answer about that, either. Can you help?
I’m sorry to hear about your husband. It’s not easy to predict life expectancy, and physicians aren’t good at it. There are computer models to help, but none I could find for someone with advanced cancer. Physicians tend to be overly optimistic, but the main issue is that, like people, cancers are unique, and there is a great deal of variability.
Roughly 30% of people with advanced (Stage 4) prostate cancer will be alive in five years. How fast the tumour is spreading, his overall health and his age, and his past treatments all are factors to consider.
Considering all people diagnosed with advanced prostate cancer, roughly one in 10 will succumb within six months. Most will live between 1.5 and six years. One in 10 will still be alive after 10 years.
Pain is also highly variable. Some people have a great deal of pain; a very few have none at all. In my experience, most will develop some degree of pain, especially as the disease progresses. Prostate cancer tends to spread to the bone, and these can be painful. Pain can be controlled, but it’s best to start treatment early, as pain is easier to control when treatment is started before pain gets out of control.
I hope you and your husband are able to make the most out of his remaining time, no matter how long that turns out to be.
Dr. Roach Writes: A recent column on intractable hiccups generated a great deal of well-intended advice and suggestions from readers. Several were quite insistent that I send the advice along to the person who wrote to me. Having taken care of a few people with this problem, I can assure my readers that these methods have been tried before it’s time to think about powerful medication.
That being said, the advice might still help people with annoying — but not quite to the point where they are medically intractable — hiccups.
Here are some of the suggestions I received from readers:
• Fill a glass with a small amount of water, bend over and drink from the glass on the opposite side of the glass, in other words from the side that is farthest from your face. The glass would be tilted backward as you do this.
• Deliberately swallow air to force a belch.
• Eat a spoonful of peanut butter or sugar. Ginger ale is another suggestion.
Another reader noted that the hiccup seemed to predict a pituitary tumour. Several readers wrote that chlorpromazine (Thorazine) was very effective and not at all difficult, while others said although it was helpful, the side effects were horrendous.
As always, I am amazed by the diversity of people’s experiences and pleased that many people took the time to write to try to help a person who was suffering.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu