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Long-term outcomes data do not support aggressive treatment of localized low-grade prostate cancer

A recent study supported by the Agency for Healthcare Research and Quality (HS09578) reports long-term outcomes of 767 men aged 55 to 74 who were diagnosed with clinically localized prostate cancer between January 1, 1971, and December 31, 1984. The study participants were managed conservatively—either by observation or by androgen withdrawal therapy alone—and followed for a median of 24 years after diagnosis. The study was led by Peter C. Albertsen, M.D., M.S., of the University of Connecticut in Farmington.

Among those patients presenting with low-grade disease (Gleason score of 2-4) on biopsy, the risk of disease progression remained low even after more than 20 years. Only 7 percent of patients with low-grade disease died of prostate cancer, while 83 percent died from other identifiable or unknown causes. Twelve percent of the men were still alive 20-33 years after diagnosis. In contrast, among men with high-grade tumors (Gleason score of 8-10), a majority died of prostate cancer within 10 years, regardless of their age when diagnosed. Only 1 percent of patients with high-grade tumors survived to the end of the study. Those who had moderate-grade tumors had an intermediate long-term risk of dying as a result of their prostate cancer.

Findings from this study demonstrate that men with low-grade prostate cancer have only a small risk of prostate cancer progression even after 20 years of management by observation or androgen withdrawal therapy alone. These results do not support aggressive treatment of localized low-grade prostate cancer, concludes Dr. Albertsen.

For more information, see "20-year outcomes following conservative management of clinically localized prostate cancer," by Dr. Albertsen, James A. Hanley, Ph.D., and Judith Fine, B.A., in the May 4, 2005, Journal of the American Medical Association 293(17), pp. 2095-2101.

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