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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

From the Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences; Department of Urology, National Naval Medical Center, Bethesda; Department of Urology, Malcolm Grow Air Force Medical Center, Andrews Air Force Base, MD; Urology Service, Department of Surgery, Walter Reed Army Medical Center; Urology Service, Department of Surgery, Eisenhower Army Medical Center, Washington, DC; Department of Urology, San Diego Naval Medical Center, San Diego, CA; Urology Service, Department of Surgery, Madigan Army Medical Center, Tacoma, WA; Urology Service, Department of Surgery, Brooke Army Medical Center; Department of Urology, Wilford Hall Air Force Medical Center, Lackland Air Force Base, San Antonio, TX; and Department of Urology, Portsmouth Naval Medical Center, Portsmouth, VA.

Address reprint requests to Judd Moul, MD, Center for Prostate Disease Research, 1530 E Jefferson St, Rockville, MD 20852; e-mail: jmoul{at}cpdr.org or Timothy Donahue, MD, Department of Urology, National Naval Medical Center, Bethesda, MD 20889; e-mail: tfdonahue{at}bethesda.med.navy.mil.

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 was65.4 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.

Supported by US Army Medical Research and Materiel Command grant PCRP-DAMD17-02-1-0066, funded by the US Department of Defense.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army, Navy, or Air Force or the Department of Defense.

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