Natural history of localised prostatic cancer managed by conservative therapy alone

The natural history of localised prostatic cancer was studied prospectively over 7 years. Within a single health district all patients with histologically confirmed cancer and negative 99mTc bone scans were managed, irrespective of clinical stage or pathological grade, according to a conservative regimen that included no form of anti-cancer treatment other than endoscopic resection for relief of urinary symptoms. Complete records were compiled on 120 of 152 patients (mean age 74.8 years, range 62-90) without metastases at diagnosis. Local tumour increased to palpable dimensions (T2/T3) in 100 of these patients (84%) but metastases developed in only 13, the mean time to scan conversion being 35.8 months. 23 patients were withdrawn from study and treated because of concern about increasing tumour size, and metastases developed in 1 of these. 5 patients died of prostatic cancer but the disease was not responsible for 48 additional deaths. Actuarial survival rates (excluding non-cancer deaths) at 5 and 7 years were 80% and 75%, respectively; the corresponding rate for those with metastases at presentation was 13% at 5 years. The likelihood that prostatic cancer will cause death within 7 years is indicated primarily by the scintigraphic findings at diagnosis.