[The natural course of untreated, localized primary prostate carcinoma]

In a population-based study, disease progression and survival were evaluated in primary untreated patients with newly diagnosed cancer of the prostate without distant metastases. Complete follow-up was achieved in 223 eligible patients with localized disease. These patients were treated with hormones if they had symptoms of tumor progression. After a medium observation time of 14 years, 73 patients experienced local tumor progression and 27 (13%) had metastases. Seventy-four percent of the patients had died, but only 11% of prostate cancer. The estimated overall and disease-specific survival after 15 years was 20.7% (95%, confidence interval 14.1-27.3%) and 80.9 (72.4-89.4%), respectively. 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.