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Diagnosed with Prostate Cancer? Do Nothing
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Peter C. Albertsen, MD, MS; James A. Hanley, PhD; Judith Fine, BA 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer. JAMA. 2005;293:2095-2101. ABSTRACT Context The appropriate therapy for men with clinically localized prostate cancer is uncertain. A recent study suggested an increasing prostate cancer mortality rate for men who are alive more than 15 years following diagnosis. Objective To estimate 20-year survival based on a competing risk analysis of men who were diagnosed with clinically localized prostate cancer and treated with observation or androgen withdrawal therapy alone, stratified by age at diagnosis and histological findings. Design, Setting, and Patients A retrospective population-based cohort study using Connecticut Tumor Registry data supplemented by hospital record and histology review of 767 men aged 55 to 74 years with clinically localized prostate cancer diagnosed between January 1, 1971, and December 31, 1984. Patients were treated with either observation or immediate or delayed androgen withdrawal therapy, with a median observation of 24 years. Main Outcome Measures Probability of mortality from prostate cancer or other competing medical conditions, given a patient's age at diagnosis and tumor grade. Results The prostate cancer mortality rate was 33 per 1000 person-years during the first 15 years of follow-up (95% confidence interval [CI], 28-38) and 18 per 1000 person-years after 15 years of follow-up (95% CI, 10-29). The mortality rates for these 2 follow-up periods were not statistically different, after adjusting for differences in tumor histology (rate ratio, 1.1; 95% CI, 0.6-1.9). Men with low-grade prostate cancers have a minimal risk of dying from prostate cancer during 20 years of follow-up (Gleason score of 2-4, 6 deaths per 1000 person-years; 95% CI, 2-11). Men with high-grade prostate cancers have a high probability of dying from prostate cancer within 10 years of diagnosis (Gleason score of 8-10, 121 deaths per 1000 person-years; 95% CI, 90-156). Men with Gleason score of 5 or 6 tumors have an intermediate risk of prostate cancer death. Conclusion The annual mortality rate from prostate cancer appears to remain stable after 15 years from diagnosis, which does not support aggressive treatment for localized low-grade prostate cancer. Author Affiliations: Division of Urology, University of Connecticut Health Center, Farmington (Dr Albertsen and Ms Fine); and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec (Dr Hanley). |
COMMENT:
What this study shows is, if you're a man aged 70 or over who's just been diagnosed with prostate cancer, the best thing you can do about it is nothing!
Prostate cancer is such a very slow-acting cancer that you're as likely to die with it as from it if it begins late enough in life. It's a harder call for men aged 55 and younger, but they also need to weigh up the disadvantages of surgery, which can include impotence and incontinence.
Oncologists usually want to attack the cancer aggressively as that's what they are trained for. But that is almost always the wrong approach according to this study. What it boils down to is that men who were aged between 55 and 74 when they were diagnosed with prostate cancer had only a slight risk of dying from the disease, even 20 years after diagnosis. And, while there are different levels of risk depending on the type of prostate cancer diagnosed — High- or low-grade — even those with high-grade cancer still have a life expectancy of 10 years if it is left alone.
Last updated 5 June 2005
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