Expectant management of localized prostatic cancer

Article Abstract:

Of roughly 4,000 patients with prostate cancer seen over a 40-year period, 75 patients with early-stage disease elected not to receive treatment and spent at least one year without treatment in a program of ''wait-and-see'' expectant management. There were no contraindications to treatment in these patients, who discussed the advantages and disadvantages of various forms of treatment with their physicians and elected to postpone therapy. Since these patients were evaluated regularly, they provide a useful group for evaluating the progression of Stage B adenocarcinoma of the prostate. All patients had histologically confirmed disease, and were classed as Stage B1, B2, or B3, depending on whether the palpable mass in their prostate was in one lobe and less than two centimeters, in one lobe and greater than two centimeters, or involving both lobes of the prostate, respectively. Follow-up revealed a varied and, in some cases, protracted, course of disease. Metastatic disease developed in 6 of 29 stage B1 patients (21 percent), in 17 of 37 Stage B2 patients (46 percent), and in 2 of 9 Stage B3 patients (22 percent). These observations confirm the relationship, observed for many cancers, that the size of the local lesion is related to the likelihood of metastatic spread. However, the greater proportion of metastatic disease in Stage B2 than B3 seems anomalous, as one might imagine that a cancer which has spread to the opposite lobe should also have been more likely to metastasize. The authors conjecture that since many of the prostate cancers metastasize in Stage B2, many may be treated before they ever have a chance to reach B3. Indeed, Stage B3 cancers may represent cancers with a reluctance to metastasize, invading only locally within the prostate. The survival at 15 years was 67 percent, 39 percent, and 63 percent, respectively, for B1, B2, and B3 patients; about half the patients who died succumbed to causes unrelated to prostate cancer. These results indicate that properly identified and carefully followed patients with early prostate cancer may live out normal life expectancies without the need for intervention at the first sign of cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Cancer invasiveness

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Analysis of prognostic factors in disseminated prostatic cancer: an update

Article Abstract:

When prostate cancer has spread through the body, chemotherapy is generally ineffective. A more effective treatment is the manipulation of hormones to slow tumor growth. Although improvements in this technique have been made, it generally only reduces side effects and improves patient comfort. Little progress has been made towards prolonging survival, and new therapies need to be tested. The testing of new therapies can be greatly facilitated if patients are grouped into different risk categories for which different treatments may be appropriate. For this reason, the cases of 191 patients with disseminated prostate cancer were reviewed to determine which characteristics carry the greatest prognostic value. Performance status, which indicates the general degree of debilitation of the patient and is measured by the Karnofsky score, was found to be a significant predictor of outcome, as were the levels of hemoglobin and the enzyme alkaline phosphatase. These factors may be used to divide patients into prognostic categories. For the patients in this study, good, moderate, and bad prognostic groups had four-year survivals of roughly 70, 40, and zero percent, respectively. However, prognostic categories will always appear to be more clear-cut for the patient population used to derive them. The authors suggest that the great heterogeneity of response to standard treatments for disseminated prostate cancer indicates that innovative combination therapy is most appropriate, especially for patients with the worst prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis

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