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Senior Citizen Health & Medicine
Octogenarians Not Too Old for Cancer Surgery, Say
Mayo Clinic Researchers
Increased wellness, safer anesthesia make it
possible for older adults to safely and effectively have surgeries, in
this case radical prostatectomy
November 27, 2006 – There have been several recent
recommendations in the last year to advance the age for a number of
treatments that had been considered too risky for the elderly. These
have included heart transplants and artificial heats. The Mayo Clinic
Cancer Center has today added surgery, in particular radical prostatectomy,
to the list. This finding, which runs counter to the conventional
practice of generally avoiding surgeries for individuals over 80 years
old solely based on age, is published today in Urology.
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The Mayo researchers conclude a radical
prostatectomy can be a viable option for select octogenarian patients.
“Increased life expectancy and generally higher
levels of wellness, as well as safer forms of anesthesia and
less-invasive surgical techniques, have made it possible for older
adults to safely and effectively have surgeries traditionally not
offered over a certain age,” says Michael Lieber, M.D., Mayo Clinic
urologist and the study’s senior investigator.
“We didn’t think that using age as the deciding
factor was a valid argument for not performing a radical prostatectomy,
and we proved that it is a safe option for some men.”
One in six men will eventually be diagnosed with
prostate cancer, reports the American Cancer Society, and more than
27,000 men will die from prostate cancer this year in the United States.
A variety of treatment options exist for this
traditionally slow-growing cancer, including hormone therapy,
chemotherapy, radiation therapy, cryotherapy, surgery and expectant
management (“watchful waiting”).
JAMA reported in 2000 that urologists typically
offer a radical prostatectomy to patients with more than 10 years of
life expectancy, and do not offer this surgical option to patients older
than age 70 to 75.
Another study, published in The New England Journal
of Medicine in 2005, showed that radical prostatectomy significantly
reduces overall mortality, local disease progression, and distant
metastases; and is associated with less hormone treatment and palliative
radiation.
In the Mayo study, Dr. Lieber’s team reviewed
records for the 19 patients age 80 or older who underwent radical
prostatectomy at Mayo Clinic from 1986 to 2003. They found that while
reasons for the radical prostatectomy varied, usually the patients
requested or even demanded the surgery.
At the time of surgery, the average patient age was
81 (range was 80 to 84), the average prostate-specific antigen (PSA)
level was 10.2 nanograms per milliliter (normal is 0 to 4 ng/ml), and
the average American Society of Anesthesiologists score (relates general
health and risk of death) was 2.4 out of five (worst).
Thirteen had pathological stage pT3 (pT4 being the
worst) disease or a Gleason score (tumor aggressiveness measurement
system) of seven or more (out of 10).
“These were patients with very aggressive forms of
prostate cancer,” says R. Houston Thompson, M.D., the study’s primary
author.
“Had our surgeons not removed the cancer, risk of
death or need for palliative care (radiation, hormones, etc.) certainly
could have become an issue.”
The researchers say the decision to perform a
radical prostatectomy for each man was reasonable, and the data agree.
Of the 19 patients, 14 remained continent, none
died within a year of surgery or from prostate cancer, and the 10-year
survival rate was similar to that observed in healthy patients 60 to 79
years old undergoing a radical prostatectomy. Only three of the 19 died
from any cause within 10 years of the surgery.
“Aging is a highly individualized process,” says
Dr. Lieber. “Decisions should be made on a case-by-case basis, but we
feel surgery can be offered to very healthy, active octogenarians with
localized prostate cancer with satisfactory results.”
Editor's Notes:
Jeffrey Slezak and W. Scott Webster, M.D., also
collaborated on this study.
For more information on prostate research at Mayo
Clinic Cancer Center, see
http://cancercenter.mayo.edu/mayo/research/prostate_program. To
learn about treatment of prostate cancer at Mayo Clinic visit
http://www.mayoclinic.org/prostate-cancer.
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