Expectant Management of Prostate Cancer With Curative Intent: An Update of The Johns Hopkins Experience

H. Ballentine Carter, Anna Kettermann, Christopher Warlick, E. Jeffrey Metter, Patricia Landis, Patrick C. Walsh, Jonathan I. Epstein

Research output: Contribution to journalArticlepeer-review

290 Scopus citations


Purpose: We updated our experience with a strategy of expectant treatment for men with stage T1c prostate cancer and evaluated predictors of disease intervention. Materials and Methods: A total of 407 men with a median age of 65.7 years (range 45.8 to 81.5) with stage T1c (99.8%) or T2a (0.2%) prostate cancer suspected of harboring small volume prostate cancer based on needle biopsy findings and prostate specific antigen density have been followed in a prospective, longitudinal surveillance program with a median followup of 2.8 years (range 0.4 to 12.5). A recommendation for treatment was made if disease progression was suggested by unfavorable followup needle biopsy findings (Gleason pattern 4 or 5, greater than 2 biopsy cores with cancer or greater than 50% involvement of any core with cancer). Cox proportional hazards regression was used to evaluate the affect of multiple covariates on the outcome of curative intervention. Results: Of 407 men 239 (59%) men remained on active surveillance at a median followup of 3.4 years (range 0.43 to 12.5), 103 (25%) underwent curative intervention at a median of 2.2 years after diagnosis (range 0.96 to 7.39) and 65 (16%) were either lost to followup (12), withdrew from the program (45), or died of causes other than prostate cancer (8). Older age at diagnosis (p = 0.011) and an earlier date of diagnosis (p = 0.001) were significantly associated with curative intervention. Conclusions: Recognizing that over treatment of prostate cancer is prevalent, especially among elderly patients, a program of careful selection and monitoring of older men who are likely to harbor small volume, low grade disease may be a rational alternative to the active treatment of all.

Original languageEnglish (US)
Pages (from-to)2359-2365
Number of pages7
JournalJournal of Urology
Issue number6
StatePublished - Dec 2007


  • age factors
  • follow-up studies
  • prostate
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology


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