Temporarily deferred therapy (watchful waiting) for men younger than 70 years and with low-risk localized prostate cancer in the prostate-specific antigen era.
OBJECTIVE
Watchful waiting (WW) is an acceptable strategy for managing prostate cancer (PC) in older men. Prostate-specific antigen (PSA) testing has resulted in a stage migration, with diagnoses made in younger men. An analysis of the Department of Defense Center for Prostate Disease Research Database was undertaken to document younger men with low- or intermediate-grade PC who initially chose WW.


METHODS
We identified men choosing WW who were diagnosed between January 1991 and January 2002, were 70 years or younger, had a Gleason score < or = 6 with no Gleason pattern 4, had no more than three positive cores on biopsy, and whose clinical stage was < or = T2 and PSA level was < or = 20. We analyzed their likelihood of remaining on WW, the factors associated with secondary treatment, and the influence of comorbidities.


RESULTS
Three hundred thirteen men were identified. Median follow-up time was 3.8 years. Median age was 65.4 years (range, 41 to 70 years). Ninety-eight patients remained on WW; 215 proceeded to treatment. A total of 57.3% and 73.2% chose treatment within the first 2 and 4 years, respectively. Median PSA doubling time (DT) was 2.5 years for those who underwent therapy; those remaining on WW had a median DT of 25.8 years. The type of secondary treatment was associated with the number of patient's comorbidities (P =.012).


CONCLUSIONS
Younger patients who choose WW seemed more likely to receive secondary treatment than older patients. PSA DTs often predict the use of secondary treatment. The number of comorbidities a patient has influences the type of secondary therapy chosen. The WW strategy may better be termed temporarily deferred therapy.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Corey A
CA
Carter
Timothy
T
Donahue
Leon
L
Sun
Hongyu
H
Wu
David G
DG
McLeod
Christopher
C
Amling
Raymond
R
Lance
John
J
Foley
Wade
W
Sexton
Leo
L
Kusuda
Andrew
A
Chung
Douglas
D
Soderdahl
Stephen
S
Jackmaan
Judd W
JW
Moul
D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D019370:Observation; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D014481:United States / Q000453:epidemiology
D017430:Prostate-Specific Antigen