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Should older men be treated aggressively for prostate cancer?

Kathleen Blanchard's picture

In an ongoing debate, researchers are trying to sort out whether or not older men should be treated aggressively for prostate cancer.

The idea of withholding prostate cancer treatment for men age 75 and beyond comes from the notion that treatment has side effects that may not be tolerated, and older men don’t have long to live.

But a new study from UCLA's Jonsson Comprehensive Cancer Center finds men who are older are being undertreated and should receive the same aggressive prostate cancer treatment as younger, healthy men.

Individual approach to prostate cancer recommended

Rather than basing treatment decisions on age, the researchers suggest and individualized approach is needed.

Men with existing health problems may not fare as well as younger men. Conversely, some men over age 75 will do better from treatment than men who are younger but have other health risks.

According to Dr. Karim Chamie, a postdoctoral fellow in urologic oncology and health services research and first author of the study, "There are individual medical problems that impact [prostate cancer] survival much more so than simply being 75 years of age."

In the study, the researchers found men with certain medical conditions are more likely to die from non-prostate cancer issues, but many are being treated as aggressively as otherwise healthy men.

The researchers looked at prostate cancer survival rates among veterans with one health risk factor and compared them to men of various ages with a variety of existing health issues.

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"Because these are VA patients, it eliminates any speculation or concern that treatment decisions were being made with reimbursement or the bottom line in mind," Chamie said. "This really speaks to the underlying psychology of physicians and how they manage patients with prostate cancer."

The scientists included prostate cancer treatment survival rates among men with COPD (chronic obstructive lung disease), diabetes with and without complications such as kidney or other organ failure, heart disease, stroke and a variety of other health risks that might complicate treatment.

One fourth of older men treated aggressively for prostate cancer

Only one fourth of the men over age 75 were receiving treatment, even though their chances of living another decade was 58 percent.

Two-thirds of the men with and without health problems were treated aggressively.

The mortality rate for men with diabetes and without organ damage was 35 percent at the ten year mark, but death was not from prostate cancer.

Other findings revealed 16 percent of men died from other causes than prostate cancer at ten years; 49 percent with peripheral vascular disease died, and 50 percent of men with diabetes were deceased who had diabetes and organ damage. Sixty-five percent with COPD also died.

"I think some physicians may think that a man with only one comorbid condition is healthier than he may in fact be," Chamie said. "Some patients, even those with just a single comorbid condition, might benefit from surveillance, as they may die as a result of other causes before their prostate cancer and avoid being exposed to some of the debilitating side effects of treatments."

The study shows just being 75 years of age or older should not be used as criteria for making a decision to treat prostate cancer aggressively.

Instead, physicians should consider other health risk factors that interfere with outcomes of aggressive prostate cancer treatment that are more important than a man’s age. The finding, published in the Journal of General Internal Medicine, shows elderly men are often undertreated for prostate cancer, based solely on age.

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Older men with prostate cancer may do best by consulting a team of professionals (from different hospitals/practices) when making their decision and also having a loved one with them during the decision-making process