NATURAL COURSE OF LOCALIZED PROSTATE-CANCER - A PERSONAL VIEW WITH A REVIEW OF PUBLISHED PAPERS

The course of untreated localized prostate cancer after 10 years of fo llow-up is at large unknown. As curative treatment is usually only off ered patients with a life expectancy exceeding 10 Yeats, the expected course of the disese if left untreated is of the utmost interest. This paper aims to describe the outcome for patients who survive far more than 10 years when treated without curative intent. The results indica te that cancer specific mortality in patients with localized prostate cancer increases steadily over time and is approximately 50% after 15 years. This is a much higher figure than in reported series on radical prostatectomy. Even if many deaths occur at an old age, prostate canc er death is shown to be associated with a significant morbidity, need for palliative treatment hospital care and cost. Preventing prostate c ancer death is therefore not only a matter of saving year of life but also to prevent suffering caused by the disease. Modern diagnostic too ls, such as prostate specific antigen, seem to detect clinically signi ficant cancers in the vast majority of patients. Over diagnosis seems to be uncommon if diagnostic procedures are restricted to patients wit h a long life expectancy. Localized prostate cancer is a slow-growing but progressive neoplastic disease. When diagnosed in a man with a lon ger life expectancy it should be handled as such.