NEW YORK (Reuters Health) – New research indicates that the outcomes of localized prostate cancer following conservative management have improved in the last few decades.

According to the report in the Journal of the American Medical Association, outcomes for conservatively managed cancers diagnosed from 1992 to 2002, the so-called PSA era, are better than those for cancers diagnosed in the 1970s and 1980s.

Exactly why outcomes have improved is unclear. “This may be due, in part, to additional lead time, overdiagnosis related to PSA testing, grade migration, or advances in medical care,” Dr. Grace L. Lu-Yao, from the Robert Wood Johnson Medical School, New Brunswick, New Jersey and colleagues state.

Their conclusions are from a study of 14,516 men with stage T1 or T2 prostate cancer who were managed without radiation or surgery for at least 6 months after diagnosis from 1992 to 2002. The outcomes of these patients were compared with outcomes of men managed conservatively in the 1970s and 1980s, as determined by review of published reports or by communication with other authors.

In the modern cohort, 10-year prostate cancer-specific mortality was 8.3% for well differentiated tumors, and 9.1% and 25.6% for moderately and poorly differentiated malignancies, respectively. The corresponding 10-year risks of dying from other causes were 59.8%, 57.2%, and 56.5%.

For men 66 to 74 years of age with moderately differentiated disease, 10-year disease-specific mortality in the current cohort was 60% to 74% lower than that of earlier cohorts: 6% vs. 15-23% (1949 to 1992). A drop in mortality was also seen for men with poorly differentiated disease.

“Considering favorable 10-year outcomes following conservative management, men with a life expectancy of less than 10 years may wish to consider an active surveillance or watchful waiting protocol as an alternative to immediate attempted curative therapy,” the authors conclude.

JAMA 2009;302:1202-1209.