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Clinical Crossroads Update
September 9, 2009

A 72-Year-Old Man With Localized Prostate Cancer—14 Years Later

JAMA. 2009;302(10):1105-1106. doi:10.1001/jama.2009.1281

In the first of 136 Clinical Crossroads articles published in JAMA since 1995, Peter C. Albertsen, MD, discussed Mr S, a 72-year-old man with localized prostate cancer.1

In 1992, Mr S was found by Dr K, his primary physician, to have slight induration of his prostate on a routine physical examination. A consulting urologist confirmed the finding and suggested a prostate biopsy after noting an elevated prostate-specific antigen (PSA) value of 4.3 ng/mL. Needle biopsy performed in 1992 was “suspicious for adenocarcinoma, but not diagnostic,” but repeat biopsy 1 year later revealed adenocarcinoma in 2 of 8 cores: 1 with a “minute focus” and 1 with a “small focus.” The areas with carcinoma were read as Gleason 3 + 3, and another area revealed “high-grade intraepithelial neoplasia.” Evaluation for metastases was negative, and prostate volume was measured as 32 cm3. A repeat PSA value was 3.8 ng/mL. In February 1994, Mr S was offered the following options: (1) he could be followed up for onset of symptoms and his PSA could be monitored; (2) he could receive radiation therapy; or (3) he could undergo a radical prostatectomy. Mr S elected to pursue “watchful waiting.”

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