P. Stattin et al., LONG-TERM OUTCOME OF CONSERVATIVE THERAPY IN MEN PRESENTING WITH VOIDING SYMPTOMS AND PROSTATE-CANCER, European urology, 32(4), 1997, pp. 404-409
Objective: To investigate the outcome of conservative therapy in men p
resenting with voiding symptoms and prostate cancer. methods: A consec
utive 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 conf
irmed the clinical suspicion of prostate cancer in 116 palpable tumors
; 47 tumors were well differentiated, 87 intermediate and 52 poorly di
fferentiated. Bone scan indicated metastasis in 24 men, all asymptomat
ic, The men were followed and underwent orchidectomy if symptoms of ge
neralized disease appeared. Results: After a followup 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 hi
ghly significant predictors for cause-specific survival in uni-and mul
tivariate analysis. Death from prostate cancer continued to occur beyo
nd 10 years after diagnosis at a decreasing rate, Conclusions: Patient
s with prostate cancer causing voiding symptoms at presentation severe
enough to necessitate TUR had a less favorable outcome than asymptoma
tic patients with prostate cancer in previously reported series, even
when stratified for stage and grade. It is suggested that voiding symp
toms at diagnosis are a putative prognostic factor in prostate cancer.