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Related Experiment Videos

If you 'watch and wait,' prostate cancer may progress dramatically

R R Allison1, A Schulsinger, V Vongtama

  • 1Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, NY 14203, USA.

International Journal of Radiation Oncology, Biology, Physics
|December 10, 1997
PubMed
Summary

Observation of untreated prostate cancer showed high rates of local progression (77%) and systemic disease (50%) in palpable tumors. This strategy may suit earlier lesions but needs rigorous testing.

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Area of Science:

  • Oncology
  • Urology
  • Cancer Research

Background:

  • Observation, or 'watch and wait', is considered for localized prostate cancer.
  • Previous studies often included patients treated with transurethral resection (TUR) or hormones, potentially confounding results.
  • The natural history of truly untreated prostate cancer requires further investigation.

Purpose of the Study:

  • To retrospectively analyze the natural history and outcomes of patients with biopsy-proven, localized prostate cancer who refused all therapy.
  • To evaluate failure patterns and survival rates in a cohort of untreated prostate cancer patients.

Main Methods:

  • Retrospective review of 34 patients diagnosed with localized prostate adenocarcinoma between 1976 and 1992.
  • Patients had biopsy-proven disease, refused therapy, had negative bone scans, and no prior TUR or hormone treatment.

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  • Median follow-up was 76 months, with analysis of local/systemic progression and survival.

    • Main Results:

    • At diagnosis, 27 patients had palpable nodules (T2) and 7 had T3 lesions, with varying differentiation.
    • Within 36 months, local progression requiring therapy occurred in 77% of patients (all T3, all moderate T2, 5/13 well-differentiated T2).
    • Systemic progression occurred in 50% of patients (6/7 T3, 9/14 moderate T2, 2/13 well-differentiated T2); 26% died from prostate cancer.

    Conclusions:

    • Observation of clinically palpable prostate cancer leads to high rates of local progression and systemic disease development.
    • The 'watch and wait' strategy may be viable for earlier stage lesions detected by PSA (prostate-specific antigen).
    • Further rigorous studies are needed to validate observation for earlier prostate cancer stages.