1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

FIFTEEN-YEAR OUTLOOK GOOD FOR PATIENTS WITH LOCALIZED PROSTATE CANCER.

The availability of PSA testing has led to an epidemic of local prostate cancer diagnoses, but do these patients benefit from early detection and radical surgery? This study describes outcomes for 642 men with prostate cancer diagnosed from 1977 to 1984 in one county in Sweden, where there is no screening for prostate cancer.

During a follow-up that averaged 14 years, 84 percent of patients died. Prostate cancer was the underlying cause of nearly 40 percent of all deaths, and accounted for a higher proportion of deaths among those younger than 61 (44 percent) than those over 80 (25 percent) at the time of diagnosis. The 15-year survival rate (corrected for other causes of death) was 72 percent among those without distant metastases at diagnosis, and 6 percent for those with such metastases. Among patients with a diagnosis of localized disease, the 15-year survival rate was similar in those who did and did not receive initial aggressive therapy (81 percent). Fifteen-year survival was worse in those with locally advanced cancer (57 percent) and those with distant metastases at diagnosis (6 percent).

Comment: This observational study would seem to support a strategy of watchful waiting for patients with localized prostate cancer. However, two editorialists are not entirely convinced; they suggest that watchful waiting "may be ideal" only in selected patients, including men with a life expectancy less than 10 to 15 years, and some men with small, well-differentiated tumors.

— TH Lee

Published in Journal Watch General Medicine February 25, 1997

Citation(s):

Johansson JE et al. Fifteen-year survival in prostate cancer: a prospective, population-based study in Sweden. JAMA 1997 Feb 12 277 467-471.

• Medline abstract (Free)

Walsh PC; Brooks JD. The Swedish prostate cancer paradox. JAMA 1997 Feb 12 277 497-498.

• Medline abstract (Free)