Older men with other illnesses may not live long enough to
benefit from aggressive prostate cancer treatments, such as prostate removal or
radiation, and they'd have to live with their side effects, says a new study.
"If you're going to die of a heart attack in five
years, what's the point of going through radiation?" asked Dr David
Penson, the study's senior author from the Vanderbilt University Medical Center
in Nashville, Tennessee."The key point is that when men are choosing
therapy for prostate cancer, they need to consider their tumor characteristics,
their age and other characteristics," he said.
About one man in every six will be diagnosed with prostate
cancer during his lifetime, according the American Cancer Society (ACS). While
it can be a serious disease, the ACS says most men don't die from the
Many chose surgery
Still, many choose to have surgery and/or radiation to treat
the cancer, even though it can lead to side effects that impact quality of
life, including erectile dysfunction, incontinence and other problems .As an
alternative to surgery and radiation, some doctors recommend so-called active
surveillance, also known as watchful waiting.
For the new study published in the Annals of Internal
Medicine on Monday, Penson and his colleagues used data from a national
database to see what effects age, other illnesses and tumour characteristics had
on risk of death from cancer and other conditions.
The researchers included men between the ages 39 to 89 years
old who were diagnosed with early-stage prostate cancer between October 1994
and October 1995.They collected information on the men's other conditions -
including diabetes, heart problems, and strokes - and tracked them through the
database over 14 years.
Risk of dying from
high-risk prostate cancer
Over that time, the researchers found the risk of dying from
high-risk prostate cancer was 18%. The risk of dying from low-risk prostate
cancer was 3% and 7% for high-risk disease. Older men were more likely to die
from something else during the 10 years following diagnosis if they had other
For example, about 40% of men between the ages of 61 and 74
years old died within the 10 years after their prostate cancer diagnosis if
they had three or more comorbidities, compared to 71% of men 75 years
old and older.
"This is just the type of study we need at this time to
help us determine who will and will not benefit from treatment," said Dr H
Ballentine Carter, a urologist and oncologist at Johns Hopkins School of
Medicine in Baltimore. But Carter, who was not involved with the new study,
told Reuters Health it's important to look at each individual patient.
"For that (75-year-old) guy who has no comorbidities or
few, he may be more likely to benefit from treatment than the 60-year-old who
has a low-grade tumour and multiple comorbidities," he said."The
challenge for the physician is to accurately evaluate the life expectancy of a
patient in order to balance the risk for prostate cancer mortality with that of
other-cause mortality," wrote Italian Drs Lazzaro Repetto, Angela Marie
Abbatecola and Giuseppe Paolisso in an editorial accompanying the study.
Penson and his colleagues, caution however, that their
results shouldn't be used to decide whether or not a person should be screened
for prostate cancer. Currently the US Preventive Services Task Force, a
government-backed panel, recommends against prostate cancer screening for
average-risk men of all ages.
Earlier this month, the American Urological Association made
news when they recommended against screening average-risk men under age 55 or
any man over 70 using prostate-specific antigen, or PSA, blood tests.