title: If you 'watch and wait,' prostate cancer may progress dramatically.
abstract: OBJECTIVE
  Observation has been proposed as an option for localized prostate cancer. However, most series reporting on 'watch and wait' include patients treated by TUR or hormones that may affect results. We retrospectively reviewed the natural history of truly untreated prostate cancer and report the outcome for these patients.
  
  
  METHODS
  From 1976 to 1992, 34 patients of median age 70 years (range 56-88) with biopsy proven localized adenocarcinoma of the prostate refused therapy. All had negative bone scan and none underwent TUR or hormone treatment. No patient was lost to follow-up (median 76 months). Failure patterns and survival were analyzed.
  
  
  RESULTS
  At diagnosis 27 patients had palpable nodules (T2), of which 13 were well differentiated and 14 moderately differentiated. Seven had moderately differentiated T3 lesions. Mild prostatitis including nocturia, hesistancy, and urgency were reported in 16 T2 and 6 T3 patients. Within 36 months, local progression requiring therapy occurred in all T3, all T2 moderate and 5 of 13 T2 well-differentiated patients. Systemic progression occurred in 6 of 7 T3, 9 of 14 T2 (mod), and 2 of 13 T2 (well) patients. Overall 59% are alive, 26% succumbed to prostate carcinoma and 15% to other causes.
  
  
  CONCLUSIONS
  Observation results in a high rate of local progression requiring intervention (77%) and excessive systemic disease development (50%) for patients with clinically palpable disease. Perhaps this strategy is viable for earlier stage lesions detected by PSA but it must be tested in a rigorous fashion before accepted.
authors.affiliation: Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, NY 14203, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Allison
authors.forename: A
authors.initials: A
authors.lastname: Schulsinger
authors.forename: V
authors.initials: V
authors.lastname: Vongtama
authors.forename: P
authors.initials: P
authors.lastname: Grant
authors.forename: K H
authors.initials: KH
authors.lastname: Shin
authors.forename: R
authors.initials: R
authors.lastname: Huben
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D012189:Retrospective Studies; D016312:Treatment Refusal
chemical_list: D017430:Prostate-Specific Antigen