In the pre-PSA era a group of 767 men with localized prostate cancer treated by either just watching it or either immediate or delayed hormones were followed for 24 years. Men who had surgery or radiotherapy were excluded from this study. The average age was 69 and most men were diagnosed in 1980 and 94% of men were followed until death. At the last follow up 61% of men had died from causes other than prostate cancer while 29% had died from prostate cancer. The key messages were:
Therefore Gleason 5-6 disease does not need aggressive treatment; however the difficulty is that when a man with Gleason 5-6 has a long life expectancy or is diagnosed young then it is likely that despite these findings they will still be offered treatment.