There are no right or wrong answers for men with prostate cancer when trying to decide what treatment to have, or even if they want to have treatment. One vital piece of information that is often left out of the equation is the chance of dying from prostate cancer if a man chooses not to have any treatment at all.
In the pre-PSA period Albertsen PC, Hanley JA, Gleason DF, Barry MJ.JAMA 1998 Sept. 16;280(11):975-80, “Competing Risk Analysis of Men Aged 55 to 74 Years at Diagnosis Managed Conservatively for clinically Localized Prostate Cancer” performed one of the largest studies that evaluated the actual risk of death a man would have if he chose not to have any sort of treatment. The results are summarized:
• Men with tumors that have Gleason scores of 2 to 4 face a 4% to 7% chance of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis.
• Men with tumors that have a Gleason score of 5 face a 6% to 11% chance of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis
• Men with tumors that have a Gleason score of 6 face a 18% to 30% chance of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis
• Men with tumors that have a Gleason scores of 7 face a 42% to 70% chance of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis and
• Men with tumors that have Gleason scores of 8 to 10 face a 60% to 87% chance of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis.
A possible confounding issue does need to be factored into the decision; these results reflect a time when most men who were diagnosed had already progressed. Today, with the use of