Men over 75 with prostate cancer who are otherwise healthy are being undertreated for their condition, according to a new study.
Meanwhile, younger men with prostate cancer who are affected by other health problems or "co-morbid" conditions are being treated for their cancer, but not responding as well as expected, University of California, Los Angeles researchers found.
"This study suggests that men with certain medical conditions are being treated just as aggressively for their prostate cancer as men who are healthy, even though they are more likely to die of non-prostate cancer causes. Conversely, men over 75 are not being aggressively treated when they may, in fact, fare better than younger men with complicating health issues," the study's first author, Dr Karim Chamie, a postdoctoral fellow in urologic oncology and health services research, said in a UCLA news release.
"There are individual medical problems that impact survival much more than simply being 75 years of age," Chamie added.
In conducting the study, the researchers examined the medical records of more than 1,000 men diagnosed with prostate cancer who were being treated at a federally subsidised Veterans Affairs Medical Center.
The researchers specifically chose the VA hospital in order to eliminate speculation that treatment decisions were also bottom-line cost decisions. "This really speaks to the underlying psychology of physicians and how they manage patients with prostate cancer," Chamie explained in the news release.
Although men with prostate cancer who were also being treated for another co-existing medical issue (such as chronic obstructive pulmonary disease, diabetes and peripheral vascular disease) had lower survival rates than other men, their cancer was treated just as aggressively, the investigators found.
The study revealed that of the roughly two-thirds of men who underwent aggressive treatment for prostate cancer, only 16% who had no other health problems died of other causes after 10 years.
Other health-related problems
In contrast, 35% of men who also had diabetes died of causes not related to their cancer after 10 years. Meanwhile, the study showed 50% of diabetic men who had organ damage related to the condition died within that time frame for reasons not cancer-related.
Similarly, 49% of men who also had peripheral vascular disease who were treated for their cancer were dead within 10 years, and 65% of men with moderate to severe chronic obstructive pulmonary disease also died. In both of those situations, the men died for reasons not related to cancer, according to the findings published in the Journal of General Internal Medicine.
"I think some physicians may think that a man with only one co-morbid condition is healthier than he may in fact be," said Chamie. "Some patients, even those with just a single co-morbid 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."
In taking the age of the men into account, however, the study revealed that only about 25% of 75-year-olds were being treated for their prostate cancer, even though they had a 58% chance of surviving another decade.
"This study suggests that while physicians use patient age of 75 as a very strong cue to avoid overtreatment of men with prostate cancer, they are less likely to integrate certain co-morbidities into prostate cancer decision making," concluded Dr. Mark S. Litwin, chairman of the urology department and a researcher at UCLA's Jonsson Comprehensive Cancer Center, in the release. "There are some medical conditions that portend a poor prognosis and should therefore be taken into consideration in the decision-making process." (HealthDay, September 2011)
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