Age, Other Illnesses May Make Prostate Cancer Treatment Unnecessary
TUESDAY May 21, 2013 -- Aggressive treatment for prostate cancer may not be warranted for many older patients with underlying medical conditions, a new study finds.
Treatments for prostate cancer, such as surgery, radiation and radioactive seed implants, can cause serious side effects, such as erectile dysfunction, urinary incontinence and bowel problems, explained researchers from the University of California, Los Angeles (UCLA).
They found that older patients with slower growing forms of prostate cancer who have at least three other health problems are more likely to die of something other than cancer. The findings might help educate patients on the risks and benefits of treatment, the team said.
"For men with low- to intermediate-risk disease, prostate cancer is an indolent [slow-growing] disease that doesn't pose a major risk to survival," study author Timothy Daskivich said in a university news release. "The take home point from this study is that older men with multiple underlying health problems should carefully consider whether they should treat these tumors aggressively, because that treatment comes with a price," said Daskivich, who is Robert Wood Johnson fellow at UCLA.
In the study, the researchers analyzed the 14-year survival outcomes of 3,000 men diagnosed with prostate cancer between 1994 and 1995. Within six months of their diagnosis, the men completed surveys to document any other medical conditions they had.
Daskivich's team focused on older patients with three or more underlying health problems, such as diabetes, hypertension, congestive heart failure and/or arthritis.
They found the 10-year risk of dying from something other than prostate cancer for men aged 61 to 74 was 40 percent, and the 14-year risk of dying from low or intermediate risk prostate cancer was only 3 percent.
For men older than 75, the 10-year risk of dying from something other than cancer was 71 percent and their 14-year risk of dying from prostate cancer was only 7 percent.
"This was a great opportunity to get a glimpse at the long-term outcomes of these men diagnosed with prostate cancer in the mid-1990s," Daskivich said, and "the risk of dying from their cancer paled in comparison to the risk that they'd die from something else."
His advice: "If you're very unlikely to benefit from treatment, then don't run the risk and end up dealing with side effects that can significantly impact quality of life. It's important for these men to talk to their doctors about the possibility of forgoing aggressive treatment. We're not talking about restricting care, but the patient should be fully informed about their likelihood of surviving long enough to benefit from treatment."
The study authors pointed out it may take eight to 10 years for the survival benefits of treatment to emerge. In many cases, they said, closely monitoring prostate cancer is better than treating the disease as aggressively as possible.
The researchers noted however that men with high-risk forms of prostate cancer may still benefit from aggressive treatment. The study found that older men's 14-year risk of death from high-risk prostate cancer was 18 percent.
According to the U.S. National Cancer Institute, in 2013 nearly 240,000 American men are expected to develop prostate cancer.
The study was published online on May 21 in Annals of Internal Medicine.
The U.S. National Cancer Institute provides more information on prostate cancer.
Posted: May 2013