High 10-year survival rate in patients with early, untreated prostatic cancer.

OBJECTIVE

To learn about the natural history of untreated, early-stage prostatic cancer.

DESIGN

Cohort study with a mean follow-up of 123 months (range, 81 to 165 months).

SETTING

Population-based, regionally well defined.

PATIENTS

A consecutive sample of 223 patients (98% of all eligible) with early-stage (T0-2, NX, M0), initially untreated prostatic cancer.

MAIN OUTCOME MEASURES

Progression-free, disease-specific, and overall survival. Need for palliative and terminal care.

INTERVENTION

Patients with tumor progression were hormonally treated (orchiectomy or estrogens) if they had symptoms.

RESULTS

After complete follow-up, only 19 (8.5%) of the 223 patients had died of prostate cancer and 105 (85%) of a total of 124 deaths were from other causes. The 10-year, disease-specific survival rate was 86.8% (95% confidence interval, 80.7% to 92.9%) and was equally high (87.9%) in a subgroup of 58 patients who met current indications for radical prostatectomy. The progression-free, 10-year survival rate was 53.1% (95% confidence interval, 44.2% to 62.0%). In 50 of 76 patients, local growth provided the only evidence of progression, and endocrine treatment was generally successful in these cases. Following an initial increase, the rate of disease progression and death from prostate cancer decreased during the last years of follow-up.

CONCLUSION

The low disease-specific mortality rate, especially in patients with highly and moderately differentiated tumors, means that any local or systemic therapy intended for patients with early prostatic cancer must be evaluated in clinical trials with untreated controls for comparison.