Natural history of early, localized prostate cancer - PubMed (original) (raw)
Natural history of early, localized prostate cancer
Jan-Erik Johansson et al. JAMA. 2004.
Abstract
Context: Among men with early prostate cancer, the natural history without initial therapy determines the potential for survival benefit following radical local treatment. However, little is known about disease progression and mortality beyond 10 to 15 years of watchful waiting.
Objective: To examine the long-term natural history of untreated, early stage prostatic cancer.
Design: Population-based, cohort study with a mean observation period of 21 years.
Setting: Regionally well-defined catchment area in central Sweden (recruitment March 1977 through February 1984).
Patients: A consecutive sample of 223 patients (98% of all eligible) with early-stage (T0-T2 NX M0 classification), initially untreated prostatic cancer. Patients with tumor progression were hormonally treated (either by orchiectomy or estrogens) if they had symptoms.
Main outcome measures: Progression-free, cause-specific, and overall survival.
Results: After complete follow-up, 39 (17%) of all patients experienced generalized disease. Most cancers had an indolent course during the first 10 to 15 years. However, further follow-up from 15 (when 49 patients were still alive) to 20 years revealed a substantial decrease in cumulative progression-free survival (from 45.0% to 36.0%), survival without metastases (from 76.9% to 51.2%), and prostate cancer-specific survival (from 78.7% to 54.4%). The prostate cancer mortality rate increased from 15 per 1000 person-years (95% confidence interval, 10-21) during the first 15 years to 44 per 1000 person-years (95% confidence interval, 22-88) beyond 15 years of follow-up (P =.01).
Conclusion: Although most prostate cancers diagnosed at an early stage have an indolent course, local tumor progression and aggressive metastatic disease may develop in the long term. These findings would support early radical treatment, notably among patients with an estimated life expectancy exceeding 15 years.
Comment in
- Waiting time in prostate cancer.
Neugut AI, Grann VR. Neugut AI, et al. JAMA. 2004 Jun 9;291(22):2757-8. doi: 10.1001/jama.291.22.2757. JAMA. 2004. PMID: 15187059 No abstract available. - Natural history of early localized prostate cancer.
Oláno JP. Oláno JP. JAMA. 2004 Oct 6;292(13):1549; author reply 1549-50. doi: 10.1001/jama.292.13.1549-b. JAMA. 2004. PMID: 15467048 No abstract available. - Natural history of early localized prostate cancer.
Osborn JR, Chodak GW. Osborn JR, et al. JAMA. 2004 Oct 6;292(13):1549; author reply 1549-50. doi: 10.1001/jama.292.13.1549-a. JAMA. 2004. PMID: 15467049 No abstract available. - Mortality rate from early prostate cancer increased 3 fold after 15 years following the diagnosis.
Barry MJ. Barry MJ. ACP J Club. 2005 Jan-Feb;142(1):24. ACP J Club. 2005. PMID: 15656565 No abstract available.
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