Natural history of early, localized prostate cancer.
BACKGROUND
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.


METHODS
Population-based, cohort study with a mean observation period of 21 years.


METHODS
Regionally well-defined catchment area in central Sweden (recruitment March 1977 through February 1984).


METHODS
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.


METHODS
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).


CONCLUSIONS
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.
Johansson
Jan-Erik
JE
Department of Urology, Orebro University Hospital, Orebro, Sweden. jan-erik.johansson@orebroll.se
Andrén
Ove
O
Andersson
Swen-Olof
SO
Dickman
Paul W
PW
Holmberg
Lars
L
Magnuson
Anders
A
Adami
Hans-Olov
HO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010641:Phenotype; D016012:Poisson Distribution; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D016019:Survival Analysis