THE NATURAL-HISTORY OF PROSTATE CARCINOMA BASED ON A DANISH POPULATION TREATED WITH NO INTENT TO CURE

BACKGROUND. Prostate carcinoma is one of the most commonly diagnosed c ancers among Western males. In Denmark, the traditional therapeutic ap proach to prostate carcinoma regardless of tumor stage has been limite d to palliative procedures. This conservative approach combined with a complete cancer and personal registration in Denmark provides an oppo rtunity to describe the still debatable natural history of prostate ca rcinoma. METHODS. The data, originating from hospital records and deat h certificates, included a complete prostate carcinoma population resi ding in Aarhus County diagnosed between January 1, 1979 and December 3 1, 1983. The patients were retrospectively followed from diagnosis unt il death (median length of follow-up, 15.0 years). RESULTS. The total number of 719 new cases of prostate cancer were diagnosed without any screening programs. Forty-five percent of patients were diagnosed inci dentally, and 31% of all patients had organ-confined disease (T1a-T2, Nx, MO). The disease specific survival rates at 1, 5, and IO years wer e 80%, 38%, and 17%, respectively, and 62% of the patients died primar ily of prostate carcinoma. A multivariate analysis demonstrated a stat istically significant relationship between disease specific death and T classification, tumor differentiation, and erythrocyte sedimentation rate at diagnosis. CONCLUSIONS. Prostate carcinoma patients have a po or survival and the majority of the patients diagnosed suffer and die from their disease rather than with it. Nevertheless, approximately on e-third of patients neither suffer nor die from their disease. Therefo re, the development of prognostic markers to improve the identificatio n of patients who will benefit from early aggressive treatment is impo rtant. (C) 1997 American Cancer Society.