It’s better to treat prostate cancer in elderly people aggressively rather than wait and watch for signs of progression, as is commonly done, according to a new study that might change the care for many victims of the deadly disorder.
Surgery or radiation therapy in elderly men increases survival by at least 30 percent, raising median survival times from 10 years to more than 13 years, researchers reported Saturday at a prostate symposium in San Francisco.
The finding in nearly 50,000 men “challenges long-held beliefs about prostate cancer treatment,” said Dr. Paul Lange of the University of Washington, by suggesting that treatment is better than so-called watchful waiting. Lange did not participate in the study.
“It’s a wonderful paper that validates what many of us have believed for a long time,” said Dr. Mark Kawachi, director of the prostate cancer center at City of Hope National Medical Center in Duarte, Calif. “Age, in and of itself, is not a definitive determinant of whether you should be excluded from treatment” for prostate cancer.
Prostate cancer is the most common type of cancer among men, with more than 234,460 new cases diagnosed in the United States this year and about 27,350 deaths, according to the American Cancer Society. It’s primarily a disease of the elderly, with about two-thirds of victims over 65.
But there is an “incredible controversy” over how to treat those older patients, said Dr. Yu-Ning Wong of the Fox Chase Cancer Center in Philadelphia, who led the new study. While it is clearly beneficial to treat younger men with the disease, many oncologists put off treatment of older patients on the assumption that most prostate cancers are slow growing. They reason that the victim is likely to die from some other cause before the prostate cancer becomes a serious problem.
Wong’s study is the first to compare treatment and no treatment in this age group. It’s an observational study, so its results cannot be considered definitive, but the findings should provide guidance to physicians and patients who are unsure how to proceed.
“There is a misconception that prostate cancer is universally an innocuous disease of the elderly,” said Dr. Howard Scher, chief of genitourinary oncology at the Sloan-Kettering Memorial Cancer Center in New York. With Wong’s and other studies, “We are clearly seeing that is not the case.”
Wong’s team studied Medicare records for 48,606 men between 65 and 80 who had survived for a year after a prostate cancer diagnosis. All were diagnosed between 1991 and 1999, with a median age of 72 at diagnosis.
A total of 19,948 men received radiation therapy and 14,098 underwent surgery, while the remaining 14,560 were simply observed.
Wong reported Saturday that only 27 percent of the men in the watchful waiting group were still alive, with a median survival time – the period in which half the patients died – of 10 years. In contrast, 59 percent of those who received either surgery or radiation therapy were still alive, with a median survival time of 13 years and growing.
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