PURPOSE: The long natural history of early stage @entity263 is well recognized and a conservative approach to the treatment of elderly @entity1 is often encouraged. We assessed the ability of @entity1 and physicians to adhere to a policy of watchful waiting in the @entity1486 ( @entity1486 ) @entity7971 . MATERIALS AND METHODS: We retrospectively reviewed the records of all 199 @entity1 with stages @entity263 and @entity1486 less than 20 ng./ml. who in our practice elected watchful waiting. Median followup in the population overall was 3.4 years. We performed Kaplan-Meier actuarial analysis of overall and disease specific survival, and most pertinent survival free from therapy. A questionnaire was administered to record the attitude of @entity1 who ultimately proceeded to treatment to determine how therapy was triggered. RESULTS: Median @entity1 age was 71 years and median @entity1486 was 6.6 ng./ml. The @entity5 was impalpable in 52% of @entity1 , Gleason sum was 6 or less in 80% and 11% used some form of herbal remedy or nutritional supplementation. Of the 37 @entity1 who died during observation, including 35 of co-morbid illness, only 6 underwent treatment. Overall survival at 5 and 7 years was 77% and 63% but disease specific survival was 98% and 98%, respectively. A total of 64 @entity1 underwent treatment and actuarial freedom from treatment was 56% at 5 years, including 51% and 73% in those younger and older than 75 years at diagnosis. The likelihood of being alive and free from treatment was 43% at 5 years and 26% at 7. Of the 63 @entity1 treated 48 (76%) underwent radical therapy (brachytherapy in 17, external beam radiotherapy in 29 and prostatectomy in 2), while only 24% received @entity342 deprivation. The median @entity1486 increase from diagnosis to treatment in treated @entity1 was 2.9 ng./ml., and it was 0.9 ng./ml. from diagnosis to the last followup in those not treated. Of the treated @entity1 81% believed that the physician had initiated therapy due to a @entity1486 increase or a nodule. However, physicians recorded having advocated treatment in only 24% of cases. CONCLUSIONS: When @entity1 do not die of co-morbid illness, they are likely to proceed to therapy well within the first decade after diagnosis (57% by 5 years and 74% by 7). Therapy was usually definitive (radical) and triggered by slight, inevitable @entity1486 increases. The @entity1 perception was that the physicians initiated therapy in response to increasing @entity1486 . However, the physicians more often perceived that treatment was initiated by @entity1 . Therefore, watchful waiting in the @entity1486 @entity7971 often represents radical therapy delayed by a few years.

Conservative management of @entity263 in the @entity1486 XXXX : the incidence and time course of subsequent therapy.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'men'] @entity7971 :: ('26284', 'Gene') :: ['era'] @entity263 :: ('MESH:D011471', 'Disease') :: ['prostate cancer', 'T1-2 prostate cancer'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity342 :: ('CHEBI:50113', 'Chemical') :: ['androgen'] @entity1486 :: ('354', 'Gene') :: ['PSA', 'prostate specific antigen']
@entity7971 :: (26284,Gene) :: ['era']
