Non-metastatic prostate cancer: rationale for conservative treatment and impact on disease-related morbidity and mortality in the elderly

Figures & data

Figure 1. Rationales for offering conservative treatment or watchful waiting in non-metastatic patients in the Vestfold Mortality Study (N = 117). *Positive lymph nodes were diagnosed by surgical lymph node staging. According to national treatment protocols, at the time positive lymph nodes were a contraindication for radical treatment.

Figure 2. Charlson Comorbidity Index (CCI, left) and ECOG performance status (right) at diagnosis for patients with non-metastatic prostate cancer who received no local treatment due to age (NoTreat/Age, N = 43).

Table 1. Characteristics of all patients with non-metastatic PC at diagnosis, who later died of PC and who received no local treatment (n = 117).

	NoTreat/other	NoTreat/age
Patients
No. of patients	74	43
Median age at diagnosis (IQR)	70 (63–75)	79 (76–83)
Median age at death (IQR)	79 (72–84)	87 (86–89)
Median time diagnosis to death, years (IQR)	8 (5–11)	7 (5–9)
ECOG at diagnosis, No (%)
0	54 (73)	8 (19)
1	10 (14)	31 (72)
≥2	10 (14)	4 (9)
Median estimated 10-year survival at diagnosis by Charlson score , % (IQR)	77 (53–90)	53 (53–77)
Tumor characteristics at diagnosis
Median PSA, µG/L (IQR)	18 (13–34)	26 (15–51)
ISUP grade group, No (%)
ISUP group 1 (Gleason≤ 6)	13(17)
ISUP group 2 (Gleason 7A)	23 (31)	13 (30)
ISUP group 3 (Gleason 7B)	9 (12)	9 (21)
ISUP group 4 (Gleason 8)	16 (22)	9 (21)
ISUP group 5 (Gleason 9 + 10)	7 (9)	7 (16)
Unknown	6 (8)	1 (2)
T stage, No (%)
T1	19 (26)	10 (23)
T2	14 (19)	9 (21)
T3	38 (51)	19 (44)
T4	3 (4)	5 (12)
CRPC at death
No. of patients with CRPC (%)	74 (100)	43 (100)
Median time diagnosis to CRPC, years (IQR)	4 (2–8)	4 (2–6)
Metastasis at death, No (%)
M+	70 (95)	40 (93)
M−	4 (5)*	3 (7)*

Patients not treated locally for other reasons than age (NoTreat/Other) and patients not treated locally due to patient age (NoTreat/Age). PC: prostate cancer; NoTreat/other: no local/ curative treatment for other reasons than age; NoTreat/age: no local/ curative treatment due to patients age; CRPC: castrate-resistant prostate cancer; IQR: interquartile range; ISUP: International Society of Urological Pathology.

*Metastatic status unknown.

Figure 3. Local complications during the course of the disease in patients with no local/curative treatment due to age (NoTreat/Age, N = 43). The total incidence of >100% is a result of the occurrence of two or more complications in a single patient.