Research Highlights | Nature Reviews Cancer

You have full access to this article via your institution. Download PDF 20-YEAR OUTCOMES A 20-year outcome analysis for men with localized prostatic cancer indicates that the mortality rates

remain the same as those in the 15-year follow up, contradicting the findings of a similar study published last year. A 20-year outcome study was published in 2004 by Johansson and

colleagues on a population-based cohort of 223 men diagnosed with localized prostate cancer between 1977 and 1984. This study indicated a 3-fold increase in the prostate cancer mortality

rate in the 49 men who were still alive after 15 years. Albertsen and colleagues in 1998 published a 15-year follow up of a similar population-based study in 767 men diagnosed between 1971

and 1984 who were either not treated, but monitored, or were treated by androgen withdrawal alone. Because all surviving patients continued to be assessed after this time, a 20-year study

could be carried out to see if the prostate cancer mortality rates had changed. Of the 767 men, 610 died before March 1 1997, 107 have died since and most of the 50 survivors have been

contacted in the past 3 years. The outcome data were generated based on age at diagnosis and the Gleason score — a score based on the differentiation state of the prostate tumour cells in

two significant areas on a biopsy specimen. The results follow the same trends as reported for the 15-year follow up — the prostate cancer mortality rate was 33 per 1,000 person years during

the first 15 years (95% confidence interval (CI), 28–38) and 18 per 1,000 person years after 15 years (95% CI, 10–29) and were not statistically different. The authors suggest that the

difference between the two 20-year outcome studies could be due to histological classification and cause of death determination. Tumour histology remains a crucial diagnostic and prognostic

tool. Histology sections can be obtained from surgical biopsy, which is required for the Gleason score (as used in this study), or can be obtained by needle biopsy and classified according

to the World Health Organization system (as used in the Johansson study). Although both approaches are reliable, they might account for different grading of the severity of the disease in

patients. Both studies also used different methods to identify cause of death — Johansson _et al_. relied on medical record review whereas Albertson _et al_. relied on information on the

death certificate — introducing another possible variable. However, overall, the prostate cancer mortality rates are similar between the two studies. So, clinically, the findings of both

studies indicate that men with well-differentiated localized tumours rarely require treatment, but those with poorly differentiated tumours treated with androgen deprivation alone will

usually die from the disease, and a more aggressive regimen is warranted. The authors point out that only randomized controlled trials can address the many questions surrounding the efficacy

of screening for prostate cancer and the best course of treatment for each individual patient. Such trials are currently underway in Sweden and the United States. ORIGINAL RESEARCH PAPER

Albertsen, P. C., Hanely, J. A. & Fine, J. 20-year outcomes following conservative management of clinically localised prostate cancer. _JAMA_ 293, 2095–2101 (2005) FURTHER READING

Johansson, J. E. _et al_. Natural history of early localised prostate cancer. _JAMA_ 291, 2713–2719 (2004) RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS

ARTICLE Research Highlights. _Nat Rev Cancer_ 5, 421 (2005). https://doi.org/10.1038/nrc1645 Download citation * Issue Date: June 2005 * DOI: https://doi.org/10.1038/nrc1645 SHARE THIS

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