CONSERVATIVE MANAGEMENT WITH SYMPTOMATIC TREATMENT AND DELAYED HORMONAL MANIPULATION IS JUSTIFIED IN MEN WITH LOCALLY ADVANCED-CARCINOMA OFTHE PROSTATE

Objective To examine the clinical course following surveillance and sy mptomatic treatment, and compare the outcomes of immediate and delayed hormonal treatment in men with locally advanced prostatic cancer. Pat ients and methods Of a consecutive series of 199 men (mean age 74 year s) with T2-T4 Nx MO prostatic cancer, 110 (55%) were followed until de ath and the rest had a mean follow-up of 4.2 years. Fifty-one men rece ived immediate orchidectomy, 88 had this treatment delayed until metas tatic progression, and 60 had the treatment in the intervening period. The actuarial survival was compared with the expected survival for an age-matched healthy population in Scotland. The adjusted effect of th e timing for hormonal manipulation was assessed by including it with a ge, Gleason Score and clinical stage in a multiple Cox regression. Res ults The actuarial survival for the whole group was 17% less at 5 year s and 15% less at 10 years when compared with the expected survival fo r an age-matched population in Scotland. This was despite the fact tha t their nodal status was unknown and also those with occult metastasis (elevated serum prostatic acid phosphatase, Mla) at presentation were not excluded. In terms of metastatic progression, overall survival an d cause-specific survival, there was no significant difference between immediate and delayed hormonal treatment. Conclusion A conservative a pproach with surveillance and symptomatic treatment for locally advanc ed prostatic cancer is justified by the present evidence on disease pr ogression and survival, which do nob differ from alternative methods o f treatment as reported in contemporary literature. This study has the limitations relative to the ideal of a prospective randomized trial o n immediate versus delayed hormonal treatment, but the lack of signifi cant differences in outcome even after adjustment for other establishe d prognostic factors does suggest that there may be little to be gaine d from an immediate orchidectomy.