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Older Men Slighted when it Comes to Prostate Cancer Treatment

Kathleen Blanchard's picture

When it comes to prostate cancer treatment, older men are often slighted, compared to young men. Rather than being offered aggressive treatment, men above age 75 may be told to watch and wait, rather than receive curative therapies that include surgery and radiation.

The researchers say older age should not be a barrier to therapy that can cure prostate cancer. Treatment should be based on disease risk factors and general state of health.

The findings that older men with the disease are treated differently than younger men comes from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database, a longitudinal, observational disease registry of men with prostate cancer that included 13,805 patients.

The study results, published in the Journal of Clinical Oncology, showed that older men with high-risk prostate cancer were less likely to receive curative therapy, yet those that did had a 46 percent lower death rate.

"There is a disconnect between risk and treatment decisions among older men," said senior investigator Matthew R. Cooperberg, MD, MPH. "Patient age is strongly influencing treatment decisions, so we sought to understand whether age plays a role in risk of the disease and survival.

Cooperberg says the study found men with high-risk prostate cancer are being under-treated, something that may account for the high rates of cancer deaths.

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He also noted men with low risk prostate cancer are over-treated, leading the researchers to conclude treatment should be based more on disease risk and less on a man’s age.

Cooperberg who is a prostate cancer specialist in the UCSF Department of Urology and the Helen Diller cancer center says, "The notion of age as a primary determinant should be reconsidered. Patients with aggressive local disease should be offered a chance of aggressive therapy that might cure them regardless of their age."

He notes that the U.S. Preventive Services Task Force specifically recommends against screening men age 75 or older for prostate cancer, but those recommendations fail to take into account health status and other factors that influence life expectancy. He also explains the recommendations are based on studies of younger men.

Even though age increases the risk of complications related to prostate cancer treatment, older men should still be considered for surgery and radiation that might cure them.

The study authors concluded that older men with high-risk disease are less likely to receive aggressive prostate cancer therapy that can be life saving. Treatment decisions should not be based on age, but on disease risk.

Journal of Clinical Oncology: doi: 10.1200/JCO.2010.30.2075