Prospective, conservative management of localized prostate cancer

Currently, no randomized trials of the various treatment options for localized prostate cancer have been reported. Therefore, radical prostatectomy and external irradiation are offered as the primary management options and are thought by many to be curative.

All patients in this series with a confirmed diagnosis of cancer of the prostate, localized, were given the option of expectant management in addition to the popular ones. Therefore, 233 patients with localized Stage A and B cancer were observed prospectively and conservatively for a period of 22 years, with a management plan of watchful waiting for most patients until signs and/or symptoms of disease activity occurred. In 44 patients interstitial I-125 irradiation implantation and pelvic lymphadenectomy were performed in those who received surgical intervention.

No patient received external irradiation or radical prostatectomy in this series. The overall survival of patients was not statistically different from the United States life-tables probability for men of similar ages when the study ended for reporting purposes in June 1989. Exclusive of the 6 patients lost to follow-up, 52 patients survived less than 3 years, whereas 181 patients have survived more than 3 years.

Because of the favorable results in this expectant management study, it appears prudent that all patients with localized prostate cancer should have this management option as well as radical surgery or external irradiation.