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Long-Term Outcomes for Men with Untreated Early Prostate Cancer

The rate of disease progression was low for the first 15 years after diagnosis, but the story was quite different after that.

Watchful waiting sometimes is recommended for early, localized prostate cancer, especially in older men. To study the disease's natural history, investigators developed a remarkable prospective registry of 223 men in Sweden with localized prostate cancer that was discovered incidentally at surgery for prostatic hyperplasia or after staging for palpable prostate nodules. Patients' mean age at diagnosis was 72. Clinical and laboratory follow-up occurred every 6 months for 2 years, then annually for 10 more years, and then every 2 years; fine-needle biopsy was performed every other year for the first 6 years.

During a mean follow-up of 21 years, prostate cancer progressed in 89 men, of whom 39 (17% of all patients) developed systemic metastases and 35 (16%) died of the cancer. The overall prostate-cancer mortality rate was 22% among men who were 70 or younger and 10% among men older than 70. Rates of disease progression and mortality were stable and low for the first 15 years, with about a 3-fold increase after 15 years.

Comment: Treating early, localized prostate cancer has become more common, so this study is unlikely to be replicated. The findings suggest that treatment of localized prostate cancer -- especially cases discovered as those in this study were -- is appropriate for men who are likely to live more than another 15 years. However, the implications of these findings are unclear for management of cancers detected by prostate-specific antigen screening, in part because PSA testing has not yet been shown to reduce long-term mortality.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine June 29, 2004

Citation(s):

Johansson J-E et al. Natural history of early, localized prostate cancer. JAMA 2004 Jun 9; 291:2713-9.

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