The natural history of prostate cancer

Predicting the long-term outcome of patients who choose watchful waiting as their initial therapy for prostate cancer is difficult. The wide variation in disease progression, the impact of competing medical hazards, and the potential impact of early hormonal therapy that is characteristic of contemporary patients all conspire to compromise survival estimates dating from the pre-prostate-specific antigen (PSA) era. This article reviews the key research that has contributed to the understanding of the natural history of prostate cancer and explores the impact of PSA testing on long-term outcomes. Special attention is given to prostate cancer summary statistics, because these numbers have been impacted by the introduction of testing for PSA.