COMPETING RISK ANALYSIS OF MEN AGED 55 TO 74 YEARS AT DIAGNOSIS MANAGED CONSERVATIVELY FOR CLINICALLY LOCALIZED PROSTATE-CANCER

Context.-The appropriate therapy for men with localized prostate cance r is uncertain. Until results of clinical trials are available, men an d their physicians need guidance. Objective.-To estimate survival base d on a competing risk analysis stratified by age at diagnosis and hist ologic findings for men diagnosed as having clinically localized prost ate cancer and who were managed conservatively. Design.-Retrospective cohort study, Setting.-Connecticut Tumor Registry. Patients.-A total o f 767 men with localized prostate cancer diagnosed between 1971 and 19 84, aged 55 to 74 years at diagnosis, either not treated or treated wi th immediate pr delayed hormonal therapy, and followed up for 10 to 20 years after diagnosis. Main Outcome Measures.-Estimates of the probab ility of dying from prostate cancer or other competing hazards, Result s.-Men with tumors that have Gleason scores of 2 to 4, 5, 6, 7, and 8 to 10 face a 4% to 7%, 6% to 11%, 18% to 30%, 42% to 70%, and 60% to 8 7% chance, respectively, of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis, Conclusions.-Men wh ose prostate biopsy specimens show Gleason score 2 to 4 disease face a minimal risk of death from prostate cancer within 15 years of diagnos is, Conversely, men whose biopsy specimens show Gleason score 7 to 10 disease face a high risk of death from prostate cancer when treated co nservatively, even when cancer is diagnosed as late as age 74 years, M en with Gleason score 5 or 6 tumors face a modest risk of death from p rostate cancer that increases slowly over at least 15 years of follow- up.