Author(s): Stattin P, Holmberg E, Johansson JE, Holmberg L, Adolfsson J,
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Abstract BACKGROUND: Treatment for localized prostate cancer remains controversial. To our knowledge, there are no outcome studies from contemporary population-based cohorts that include data on stage, Gleason score, and serum levels of prostate-specific antigen (PSA). METHODS: In the National Prostate Cancer Register of Sweden Follow-up Study, a nationwide cohort, we identified 6849 patients aged 70 years or younger. Inclusion criteria were diagnosis with local clinical stage T1-2 prostate cancer from January 1, 1997, through December 31, 2002, a Gleason score of 7 or less, a serum PSA level of less than 20 ng/mL, and treatment with surveillance (including active surveillance and watchful waiting, n = 2021) or curative intent (including radical prostatectomy, n = 3399, and radiation therapy, n = 1429). Among the 6849 patients, 2686 had low-risk prostate cancer (ie, clinical stage T1, Gleason score 2-6, and serum PSA level of <10 ng/mL). The study cohort was linked to the Cause of Death Register, and cumulative incidence of death from prostate cancer and competing causes was calculated. RESULTS: For the combination of low- and intermediate-risk prostate cancers, calculated cumulative 10-year prostate cancer-specific mortality was 3.6\% (95\% confidence interval [CI] = 2.7\% to 4.8\%) in the surveillance group and 2.7\% (95\% CI = 2.1\% to 3.45) in the curative intent group. For those with low-risk disease, the corresponding values were 2.4\% (95\% CI = 1.2\% to 4.1\%) among the 1085 patients in the surveillance group and 0.7\% (95\% CI = 0.3\% to 1.4\%) among the 1601 patients in the curative intent group. The 10-year risk of dying from competing causes was 19.2\% (95\% CI = 17.2\% to 21.3\%) in the surveillance group and 10.2\% (95\% CI = 9.0\% to 11.4\%) in the curative intent group. CONCLUSION: A 10-year prostate cancer-specific mortality of 2.4\% among patients with low-risk prostate cancer in the surveillance group indicates that surveillance may be a suitable treatment option for many patients with low-risk disease.
This article was published in J Natl Cancer Inst
and referenced in Archives of Surgical Oncology