Temporarily deferred therapy (watchful waiting) for men younger than 70 years and with low-risk localized prostate cancer in the prostate-specific antigen era.

Purpose: Watchful waiting (WW) is an acceptable strategy for managing prostate cancer (PC) in older men. Prostate-specific antigen (PSA) testing has resulted in a stage migration, with diagnoses made in younger men. An analysis of the Department of Defense Center for Prostate Disease Research Database was undertaken to document younger men with low- or intermediate-grade PC who initially chose WW. Patients and Methods: We identified men choosing WW who were diagnosed between January 1991 and January 2002, were 70 years or younger, had a Gleason score ≤ 6 with no Gleason pattern 4, had no more than three positive cores on biopsy, and whose clinical stage was ≤ T2 and PSA level was ≤ 20. We analyzed their likelihood of remaining on WW, the factors associated with secondary treatment, and the influence of comorbidities. Results: Three hundred thirteen men were identified. Median follow-up time was 3.8 years. Median age was65.4 years (range, 41 to 70 years). Ninety-eight patients remained on WW; 215 proceeded...

[1]  D. Lubeck,et al.  Patterns of treatment of patients with prostate cancer initially managed with surveillance: results from The CaPSURE database. Cancer of the Prostate Strategic Urological Research Endeavor. , 2000, The Journal of urology.

[2]  H. Grönberg,et al.  Hereditary prostate cancer: clinical characteristics and survival. , 2002, The Journal of urology.

[3]  J. Stanford,et al.  Temporal trends in rates of prostate cancer: declining incidence of advanced stage disease, 1974 to 1994. , 1997, The Journal of urology.

[4]  J. Trachtenberg,et al.  Prostate specific antigen velocity as a measure of the natural history of prostate cancer: defining a 'rapid riser' subset. , 1998, British journal of urology.

[5]  L. Holmberg,et al.  Fifteen-year survival in prostate cancer. A prospective, population-based study in Sweden. , 1997, JAMA.

[6]  K. Cummings,et al.  National trends in the epidemiology of prostate cancer, 1973 to 1994: evidence for the effectiveness of prostate-specific antigen screening. , 1998, Urology.

[7]  Neil Fleshner,et al.  Feasibility study: watchful waiting for localized low to intermediate grade prostate carcinoma with selective delayed intervention based on prostate specific antigen, histological and/or clinical progression. , 2002, The Journal of urology.

[8]  G. Duncan,et al.  Watchful waiting or watchful progression? , 1998, Cancer.

[9]  J. Bishoff,et al.  Introduction to Department of Defense Center for Prostate Disease Research Multicenter National Prostate Cancer Database, and analysis of changes in the PSA-era , 2001 .

[10]  P. Schellhammer,et al.  Conservative management of prostate cancer in the prostate specific antigen era: the incidence and time course of subsequent therapy. , 2001, The Journal of urology.

[11]  D. Fryback,et al.  Long-term survival among men with conservatively treated localized prostate cancer. , 1995, JAMA.

[12]  P. Walsh,et al.  Dedifferentiation of prostate cancer grade with time in men followed expectantly for stage T1c disease. , 2001, The Journal of urology.

[13]  R. Stephenson.  Prostate cancer trends in the era of prostate-specific antigen. An update of incidence, mortality, and clinical factors from the SEER database. , 2002, The Urologic clinics of North America.

[14]  P. Walsh,et al.  Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. , 1994, JAMA.

[15]  E. Bergstralh,et al.  Outcomes for men with clinically nonmetastatic prostate carcinoma managed with radical prostactectomy, external beam radiotherapy, or expectant management , 2001, Cancer.

[16]  Herbert Lepor,et al.  Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations , 1983, The Prostate.

[17]  R. Thisted,et al.  Results of conservative management of clinically localized prostate cancer. , 1994, The New England journal of medicine.

[18]  C. Brendler,et al.  An analysis of watchful waiting for clinically localized prostate cancer. , 1998, The Journal of urology.

[19]  S. Egawa,et al.  Observations of prostate specific antigen doubling time in Japanese patients with nonmetastatic prostate carcinoma , 1999, Cancer.

[20]  D. Chan,et al.  Estimation of prostatic growth using serial prostate-specific antigen measurements in men with and without prostate disease. , 1992, Cancer research.

[21]  H. Ragde,et al.  Modern prostate brachytherapy , 2000 .