Expectant management of early stage prostatic cancer: Swedish experience

To learn about the natural history of untreated early stage prostatic cancer (stage T0-2NXM0) progression-free, disease specific, overall survival and the need for palliative care were evaluated in a population-based and regionally well defined cohort from Sweden. Complete followup, with a mean observation of 12.5 years, was achieved in 223 consecutively diagnosed, eligible patients (98%) of all ages. Patients with progression were hormonally treated (orchiectomy or estrogens) if they had symptoms. After a mean of 12.5 years only 23 patients (10%) had died of prostate cancer and 125 of 148 deaths (84%) were of other causes. The 10-year disease specific survival rate was 85% (95% confidence interval 79 to 91%) and was equally high (89%) in a subgroup of 58 patients who met current indications for radical prostatectomy. The progression-free 10-year survival rate was 55% (95% confidence interval 46 to 63%) but in 49 of 77 patients local growth provided the only evidence of progression and endocrine treatment was generally successful in these cases. Following an initial increase, the rate of disease progression and death from prostate cancer decreased during the last years of followup. The low disease specific mortality rate, especially in patients with highly and moderately differentiated tumors, means that any local or systemic therapy intended for patients with early prostatic cancer must be evaluated in clinical trials with untreated controls for comparison. One such trial is in progress in Sweden and Finland evaluating deferred treatment and radical prostatectomy. As of the beginning of December 1993, 330 patients were included in the study.