Deferred Treatment of Clinically Localized Low Grade Prostate Cancer: The Experience From A Prospective Series at The Karolinska Hospital

Pathological Upgrading and Up Staging With Immediate Repeat Biopsy in Patients Eligible for Active Surveillance

“…Although most patients diagnosed with prostate cancer will not ultimately die of their disease, treating patients for prostate cancer improves overall and cancer-specific survival compared to watchful waiting, as well as reducing the risk of developing metastatic disease 7. In fact, if a patient has a life expectancy of greater than 15 years, untreated prostate cancer eventually leads to an increasing risk of overall mortality 8–11…”

Current Controversies in the Management of Localized Prostate Cancer

“…Studies of the natural history of localized prostate can cer managed expectantly show that within 10 years most cancers grow locally, fewer patients develop métastasés, and few will die of the disease [57][58][59], The best informa tion about the natural history of clinically localized pros tate cancer managed expectantly comes from a recently published pooled analysis of 828 cases from 6 nonrandomized studies [60], The outcome (metastasis-free sur vival, cancer-specific survival) was analyzed by the grade (I, II, III) of the cancer (table 3). The authors concluded that watchful waiting may be a reasonable option for men with grade I or II cancer, especially those with a life expec tancy of less than 10 years.…”

“…But the advantage of watchful waiting is that the patient avoids (or postpones) the morbidity (and possible mortality) of definitive thera py. This strategy assumes that the patient will die of some other cause before he becomes ill from the cancer [55,57,58,60], The success of this strategy depends on our ability to assess accurately the risk posed by the patient's cancer as well as the life expectancy, or the expectancy of a healthy life, of the patient. Unfortunately, neither of these parameters can be judged with sufficient accuracy today, although several investigators have carefully analyzed the risks and the benefits of the various treatment options by compiling the best information published in the literature (table 9) [113], In the analysis by Adolfsson et al [113], poorly differentiated cancers were more common in the radical prostatectomy series than in the watchful waiting series (16.6 vs. 7.2%), yet the rate of metastatic progres sion was substantially less in the radical prostatectomy series (12.6 vs. 25%).…”

Active surveillance for favorable-risk prostate cancer: What are the results and how safe is it?

“…The results of a watchful waiting approach (ie, no treatment until progression to metastatic or locally advanced disease) has been reported by several groups [8][9][10][11][12][13][14][15][16][17]. These studies all describe nonprogression in many patients.…”