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Albertsen PC, Hanley JA, Fine J. 20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer. JAMA. 2005;293(17):2095–2101. doi:10.1001/jama.293.17.2095
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
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.
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