the writer has been impressed by the frequency of the small carcinomas that have been found in the prostate in the routine autopsy material of this department.
This observation, that small amounts of what we now call “latent” or “indolent” prostate cancer are extremely common, and may occur in the prostates of many men who have no outward clinical signs or symptoms of the disease, is at the very heart of understanding how difficult it is to decide whether and how to treat a man diagnosed with prostate cancer today.
We now know that, at least in America:
- Between 25 and 35 percent of men aged between 30 and 49 years of age will have cancer observable in their prostate at autopsy if they die for some other reason (see Sakr et al., 1993)
- Some 30 percent of all men in their 50s will also have cancer observable in their prostate at autopsy (see Franks, 1954)
- As many as 70 percent of all men in their 80s will have cancer in their prostate at autopsy (assuming they still have an untreated prostate)
Similar data appear to be true in the case of Scandinavian countries, based on their extensive tumor registry data.
In other words, the development of cancer in the prostate is a normal component of the aging process (although the risk may be affected in individuals and populations by diet, genetics, the environment, etc.).
Data available on the natural history of the conservative treatment of prostate cancer teaches us that:
- Early stage disease of relatively low risk can be managed successfully with conservative strategies in many older men with at least 10 and perhaps 15 or 20 years of life expectancy.
- More aggressive prostate cancer results in a high rate of mortality when left untreated.
- Age is an important factor in decision making.
- If early stage, low-risk disease is diagnosed at a young age, there is a risk of prostate cancer progression over time if this disease is treated conservatively, but curative treatment may still be applied long after the initial diagnosis
To get some additional understanding about when conservative treatment may be appropriate, we suggest you read the article on the natural history of conservative management of prostate cancer.