Mean time to cancer-specific death of apparently clinically localized prostate cancer: policy implications for threshold ages in prostate-specific antigen screening and ablative therapy.

Abstract

To assess the mean time to cancer-specific death in patients with prostate cancer, using a minimum follow-up of 14 years at one institution, and thus evaluate the minimum life-expectancy for eligibility for radical surgery, radiotherapy and, implicitly, prostate specific antigen (PSA) screening. The tumour registry of the authors' institution was searched for the records of patients with prostate cancer (stages T1 and nonmetastatic T2-3) over the period 1976-1983, chosen to give a maximum follow-up with sufficient numbers of patients. Kaplan-Meier curves and the mean time to death to 1995 for palpable and impalpable cancers were calculated. Deaths not from cancer and from unknown causes were censored. Patients still alive were also censored, except for in the calculation of mean time to death. Patients with both stages of disease had a steep increase in mortality at 16 years. The mean (SEM) time to prostate cancer-specific death for T1 disease was 17 (1.8) years and for T2-T3 (palpable) was 11.7 (1.2 years). These results suggest that, if there is to be one at all, the upper age limit for prostate cancer screening should be 62 years.