The natural history of locally confined prostate cancer: a review

The incidence of prostate cancer rises steeply in men over the age of 50 years. Mortality due to prostate cancer also increases, but not at the same rate as the incidence. In the U.S.A., a man has a lifetime risk of developing prostate cancer of about 1 in 11, but his risk of dying of the disease is about 1 in 22-33. Tumor DNA ploidy is one of the predictive features of the growth rate of prostate cancer. Patients with diploid tumors have a more favorable prognosis than those with aneuploid tumors, regardless of the stage or grade. Patients with stage A1 defined disease (less than 5% of the specimen being cancerous) have a relatively low risk of progression (about 12%) and death (about 3%). Evidence suggests that transurethral resection of the prostate (TURP) is effective in removing disease in about 62% of cases. Expectant management involves following a patient and giving hormonal therapy or TURP as necessary. Four studies with follow-up periods of 4-10 years have shown that the metastatic disease rate ranges from 9 to 37% and that deaths from prostate cancer range from 9 to 16%. Results from animal studies suggest that hormonal therapy only improves survival if it is given at the time of tumor implantation or shortly after, though it can be effective palliative treatment.