The study from Johansson and colleagues1 published
in this issue of THE JOURNAL illustrates why oncologists often substitute
the jargon of survival rates to sidestep using the magic word cure, which is really what's on every patient's mind.1 In
this well-conducted investigation, the researchers complete more than 2 decades
of follow-up for a cohort of more than 200 Swedish men with early-stage prostate
cancer from before the prostate-specific antigen (PSA) era who were treated
with watchful waiting. Earlier reports by Johansson et al documented the relatively
high rates of recurrence and mortality for those with high-grade tumors and
the relatively lower rates among those with low-grade tumors, extending up
to about 15 years of follow-up.2- 8 In
the current article, the authors extend their follow-up to more than 20 years
and find a surprising acceleration in the recurrence and mortality rates of
the patients with low-grade tumors.1 The result
is that more aggressive disease indeed occurs after 15 years of follow-up
for these patients.
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