[Natural disease course in untreated early prostatic carcinoma--the Orebro Study]

In a population-based study for prostate cancer, performed in one county in Sweden, without screening, disease progression and survival were evaluated. 642 patients with prostate cancer of any stage consecutively were diagnosed between 1977 and 1984 at a mid-age of 72 years with complete follow-up. Among 300 patients with a diagnosis of localized disease (T0-T2) 223 with well differentiated histology were treated with hormones only, if they had symptoms of tumor progression. In this group the 15-year survival rate, corrected for causes other than prostate cancer, was 81%. 77 other patients with localized disease received primary treatment with radiotherapy (n = 75) or radical prostatectomy (n = 2) +/- hormonal treatment. The survival rate corrected for other causes than prostate cancer was identical. In a multivariate analysis, tumor grade turned out to be a strong predictor of progression and death due to prostate cancer. The low disease--specific mortality rate, especially in patients with highly and moderately differentiated tumors, means that any therapy intended for patients with early prostate cancer must be evaluated in clinical trials with untreated controls for comparison. Without reliable prognostic indicators an aggressive approach to all patients with early disease would entail substantial overtreatment.