20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer | Oncology | JAMA | JAMA Network
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1.
Johansson JE, Andren O, Andersson SO.  et al.  Natural history of early, localized prostate cancer.  JAMA. 2004;291:2713-271915187052Google ScholarCrossref
2.
Albertsen PC, Hanley JA, Gleason DF, Barry MJ. Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer.  JAMA. 1998;280:975-9809749479Google ScholarCrossref
3.
Gleason DF. Histologic grading and clinical staging of carcinoma of the prostate. In: Tannenbaum M, ed. Urologic Pathology. Philadelphia, Pa: Lea & Febiger; 1977:171-198
4.
Draisma G, Boer R, Otto SJ.  et al.  Lead times and over detection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer.  J Natl Cancer Inst. 2003;95:868-87812813170Google ScholarCrossref
5.
Esposti PL. Cytologic malignancy grading of prostatic carcinoma by transrectal aspiration biopsy.  Scand J Urol Nephrol. 1971;5:199-2095569345Google ScholarCrossref
6.
Albertsen PC, Walters S, Hanley JA. A comparison of cause of death determination among men previously diagnosed with prostate cancer and dying in either 1985 or 1995.  J Urol. 2000;163:519-52310647669Google ScholarCrossref
7.
Penson DF, Albertsen PC, Nelson PS, Barry M, Stanford JL. Determining cause of death in prostate cancer: are death certificates valid?  J Natl Cancer Inst. 2001;93:1822-182311734600Google ScholarCrossref
8.
Holmberg L, Bill-Axelson A, Helegsen F.  et al. Scandinavian Prostatic Cancer Group Study Number 4.  A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.  N Engl J Med. 2002;347:781-78912226148Google ScholarCrossref
9.
Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC. Natural history of progression after PSA elevation following radical prostatectomy.  JAMA. 1999;281:1591-159710235151Google ScholarCrossref
10.
Thompson IM, Pauler DK, Goodman PJ.  et al.  Prevalence of prostate cancer among men with a prostate-specific antigen level of <4.0 ng per milliliter.  N Engl J Med. 2004;350:2239-224615163773Google ScholarCrossref
11.
Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years?  J Urol. 2004;172:1297-130115371827Google ScholarCrossref
12.
Murphy GP, Natarajan N, Pontes JE.  et al.  The national survey of prostate cancer in the United States by the American College of Surgeons.  J Urol. 1982;127:928-9347086995Google Scholar
13.
Catalona WJ, Smith DS, Ratliff TL, Basler JW. Detection of organ confined prostate cancer is increased through prostate-specific antigen-based screening.  JAMA. 1993;270:948-9547688438Google ScholarCrossref
14.
Schroder FH, Bangma CH. The European Randomized Study of Screening for Prostate Cancer (ERSPC).  Br J Urol. 1997;79:68-719088276Google Scholar
15.
Wilt TJ, Brawer MK. The Prostate Cancer Intervention Versus Observation Trial (PIVOT).  Oncology. 1997;11:1133-11399268976Google Scholar
16.
Gohagan JK, Prorok PC, Hayes RB, Kramer BS.Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial Project Team.  The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: history, organization, and status.  Control Clin Trials. 2000;21:(6 suppl)  251S-272S11189683Google ScholarCrossref
17.
Donovan J, Hamdy F, Neal D.  et al. ProtecT Study Group.  Prostate Testing for Cancer and Treatment (ProtecT) feasibility study.  Health Technol Assess. 2003;7:1-8812709289Google Scholar
Original Contribution
May 4, 2005

20-Year Outcomes Following Conservative Management of Clinically Localized Prostate Cancer

Author Affiliations
 

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).

JAMA. 2005;293(17):2095-2101. doi:10.1001/jama.293.17.2095
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.

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