Temporarily deferred therapy (watchful waiting) for men younger than 70 years and with low-risk localized prostate cancer in the prostate-specific antigen era

Corey A. Carter, Timothy Donahue, Leon Sun, Hongyu Wu, David G. McLeod, Christopher Amling, Raymond Lance, John Foley, Wade Sexton, Leo Kusuda, Andrew Chung, Douglas Soderdahl, Stephen Jackman, Judd W. Moul

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Abstract

Purpose: Watchful waiting (WW) is an acceptable strategy for managing prostate cancer (PC) in older men. Prostate-specific antigen (PSA) testing has resulted in a stage migration, with diagnoses made in younger men. An analysis of the Department of Defense Center for Prostate Disease Research Database was undertaken to document younger men with low- or intermediate-grade PC who initially chose WW. Patients and Methods: We identified men choosing WW who were diagnosed between January 1991 and January 2002, were 70 years or younger, had a Gleason score ≤ 6 with no Gleason pattern 4, had no more than three positive cores on biopsy, and whose clinical stage was ≤ T2 and PSA level was ≤ 20. We analyzed their likelihood of remaining on WW, the factors associated with secondary treatment, and the influence of comorbidities. Results: Three hundred thirteen men were identified. Median follow-up time was 3.8 years. Median age was 65.4 years (range, 41 to 70 years). Ninety-eight patients remained on WW; 215 proceeded to treatment. A total of 57.3% and 73.2% chose treatment within the first 2 and 4 years, respectively. Median PSA doubling time (DT) was 2.5 years for those who underwent therapy; those remaining on WW had a median DT of 25.8 years. The type of secondary treatment was associated with the number of patient's comorbidities (P = .012). Conclusion: Younger patients who choose WW seemed more likely to receive secondary treatment than older patients. PSA DTs often predict the use of secondary treatment. The number of comorbidities a patient has influences the type of secondary therapy chosen. The WW strategy may better be termed temporarily deferred therapy.

Original languageEnglish (US)
Pages (from-to)4001-4008
Number of pages8
JournalJournal of Clinical Oncology
Volume21
Issue number21
DOIs
StatePublished - Nov 1 2003

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Carter, C. A., Donahue, T., Sun, L., Wu, H., McLeod, D. G., Amling, C., Lance, R., Foley, J., Sexton, W., Kusuda, L., Chung, A., Soderdahl, D., Jackman, S., & Moul, J. W. (2003). Temporarily deferred therapy (watchful waiting) for men younger than 70 years and with low-risk localized prostate cancer in the prostate-specific antigen era. Journal of Clinical Oncology, 21(21), 4001-4008. https://doi.org/10.1200/JCO.2003.04.092