The natural history of prostate carcinoma based on a Danish population treated with no intent to cure

Prostate carcinoma is one of the most commonly diagnosed cancers among Western males. In Denmark, the traditional therapeutic approach to prostate carcinoma regardless of tumor stage has been limited to palliative procedures. This conservative approach combined with a complete cancer and personal registration in Denmark provides an opportunity to describe the still debatable natural history of prostate carcinoma.

The data, originating from hospital records and death certificates, included a complete prostate carcinoma population residing in Aarhus County diagnosed between January 1, 1979 and December 31, 1983. The patients were retrospectively followed from diagnosis until death (median length of follow-up, 15.0 years).

The total number of 719 new cases of prostate cancer were diagnosed without any screening programs. Forty-five percent of patients were diagnosed incidentally, and 31% of all patients had organ-confined disease (T1a-T2, Nx, M0). The disease specific survival rates at 1, 5, and 10 years were 80%, 38%, and 17%, respectively, and 62% of the patients died primarily of prostate carcinoma. A multivariate analysis demonstrated a statistically significant relationship between disease specific death and T classification, tumor differentiation, and erythrocyte sedimentation rate at diagnosis.

Prostate carcinoma patients have a poor survival and the majority of the patients diagnosed suffer and die from their disease rather than with it. Nevertheless, approximately one-third of patients neither suffer nor die from their disease. Therefore, the development of prognostic markers to improve the identification of patients who will benefit from early aggressive treatment is important. [See editorial on pages 827-33, this issue.]