ADULT UROLOGY ELSEVIER DEFERRED TREATMENT OF CLINICALLY LOCALIZED LOW-GRADE PROSTATE CANCER: ACTUAL lo-YEAR AND PROJECTED 15-YEAR FOLLOW-UP OF THE KAROLINSKA SERIES JAN ADOLFSSON, GUNNAR STEINECK, AND PER-OLOV HEDLUND ABSTRACT Objectives. To review the outcome in patients with clinically localized prostate cancer managed conserva- tively. Methods. A total of 122 patients with palpable, clinically localized, low-grade prostate cancer diagnosed from 1978 to 1982 at the Karolinska Hospital, Stockholm, Sweden, were prospectively followed in a sur- veillance protocol followed by treatment when the tumor progressed with symptoms. Results. All patients but one had been observed for 10 years or more. No antitumoral therapy had been given to 58 (48%) patients at follow-up or before death. The chance of being untreated 5 and 10 years after diagnosis, if still alive, was 7 1% and 43%, respectively. The actual disease-specific survival rate at 10 years was 90%. Of the patients with a possible observation period of 15 years or more, 25% died of prostate cancer (ie, an actual disease-specific survival of 75%). Using a survival plot, the projected disease-specific survival rate at 15 years was 62%. The cumulative incidence of death from prostate cancer increased with possible observation time up to 15 years. Conclusions. Our data are mature up to 10 years of observation and, based on these data, deferred treat- ment is a valid option for patients with clinically localized low-grade prostate cancer with a life expectancy of 10 years or less. The data are not definitive beyond 10 years and firm conclusions will be speculative, but our findings indicate that there probably is room for efficacious local treatment in patients with localized prostate cancer and a life expectancy longer than 10 years. UROLOGY 50: 722-726, 1997.0 1997, Elsevier Science Inc. All rights reserved. T he optimal management of men with clinically localized prostate cancer has not been estab- lished. The course of the disease in such patients diagnosed 15 to 20 years ago and undergoing con- servative management is fairly well characterized up to 10 years after the diagnosis, with a projected disease-specific survival rate close to 85%.1,2 Lit- This work was supported by grants jrom the Research Funds of the Karolinska Institute, the Swedish Cancer Society, and the Dagmar Ferb Foundation. From the Department of Urology, Karohnska Institute, Hud- dinge University Hospital, Stockholm, Sweden; the Departments of Cancer Prevention and Oncology, Radiumhemmet, Karolinska Institute, Stockholm, Sweden; and the Depurtment of Urology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden Reprint requests:Jan Ado&son, M.D., Department of Urology, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden Submitted: February 4, 1997, accepted (with revisions): May 13, 1997 0 1997, ELSEVIER SCIENCE INC. 722 ALL RIGHTS RESERVED erature compilations have only shown a marginal advantage, if any, of aggressive local treatments re- garding survival up to 10 years of observation3-* and the benefit gained from such therapies up to that point of time has been questioned.6 A certain proportion of patients with clinically localized prostate cancer will die early of the dis- ease irrespective of management, and it is likely that many of these patients have micrometastases already when diagnosed. However, the longer after the diagnosis a patient dies of prostate cancer, the less likely it is that he had micrometastases at di- agnosis. Therefore, if events of death from prostate cancer continue to occur during long-term follow- up of patients on conservative management, early efficacious local treatment might be beneficial with respect to long-term survival. The room for such treatment of patients with clinically localized pros- tate cancer may be larger than that found at 10 years of follow-up. The Karolinska series with de- 0090-4295/97/$17.00 PII s0090-4295(97)00320-8