Observation alone in the management of localized prostate cancer: The natural history of untreated disease

Objective. To review the data from a series of patients with localized prostate cancer managed with observation alone. When available, cancer-specific survival was analyzed. Predictive factors for disease outcome were reviewed. Methods. Series of patients with localized prostate cancer managed with observation alone were reviewed. When available, cancer-specific survival was analyzed. Predictive factors for disease outcome are reviewed. Results. In published trials of observation alone, ten-year cancer-specific survivals of 80-90 percent are realized. Adverse predictors of outcome include higher stage and grade as well as aneuploid tumors. Although tumor progression is more common in patients with adverse predictive factors, adverse outcomes can occur in the larger group of patients with intermediate grade, stage, or tumor volume. Conclusions. Based on a small number of studies of patients with localized prostate cancer managed with observation alone, it appears that this option is reasonable for patients with good predictive factors and for patients with shorter life expectancies. The principal advantage of observation is the avoidance of treatment-related morbidity, but for the patient whose disease progresses during follow-up, disease-related morbidity can occasionally occur.