Long-term outcome of conservative therapy in men presenting with voiding symptoms and prostate cancer

To investigate the outcome of conservative therapy in men presenting with voiding symptoms and prostate cancer.

A consecutive series of 186 men presenting with voiding symptoms and prostate cancer were treated with transurethral resection (TUR). Examination of the resected tissue revealed 70 nonpalpable prostate cancers and confirmed the clinical suspicion of prostate cancer in 116 palpable tumors; 47 tumors were well differentiated, 87 intermediate and 52 poorly differentiated. Bone scan indicated metastasis in 24 men, all asymptomatic. The men were followed and underwent orchidectomy if symptoms of generalized disease appeared.

After a follow-up of 13-21 years, 172/186 (92%) of the men had died, with 80/186 (43%) of the men dying of prostate cancer. The mean life expectancy was 6.3 years (confidence interval 5.4-7.1) compared with 10.2 years of an age-matched control group. In a subgroup of men with clinically localized disease, 26/97 (27%) died of prostate cancer. These men had a mean life expectancy of 7.1 years (confidence interval 6.0-8.3). Tumor stage and grade were highly significant predictors for cause-specific survival in uni- and multivariate analysis. Death from prostate cancer continued to occur beyond 10 years after diagnosis at a decreasing rate.

Patients with prostate cancer causing voiding symptoms at presentation severe enough to necessitate TUR had a less favorable outcome than asymptomatic patients with prostate cancer in previously reported series, even when stratified for stage and grade. It is suggested that voiding symptoms at diagnosis are a putative prognostic factor in prostate cancer.