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Senior Citizen Health & Medicine
Elderly Men Survive Prostate Cancer 'Significantly'
Longer if Treated
Editorial says best care achieved not by treating
more patients but by treating them more discerningly
December 22, 2006 – One of the most explored
questions pertaining to the health of male senior citizens – should
prostate cancer be treated - was probed again this month by an article
in JAMA. The report on an observational study suggests that elderly men
who received treatment for localized prostate cancer survived
significantly longer than men who did not receive treatment. The
investigators, however, emphasize the importance of validating these
results in randomized trials.
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Health & Medicine |
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The widespread adoption of prostate-specific
antigen (PSA) screening has led to an increasing proportion of men being
diagnosed with early-stage and low– or intermediate–grade prostate
cancer.
Studies have demonstrated the slow-developing
nature of low- and intermediate-grade prostate cancer, making management
options (observation, radiation therapy, and radical prostatectomy)
controversial, with uncertain outcomes.
This is also applies to men older than 65 years,
because of a lack of information from randomized trials. When randomized
controlled trial data are not available, observational studies can
provide insight into important clinical questions, according to
background information in the article
Yu-Ning Wong, M.D., of the Fox Chase Cancer Center,
Philadelphia, and colleagues evaluated the association of active
treatment (radiation or prostatectomy) vs. observation on overall
survival in a large sample of elderly men treated for low– or
intermediate–risk localized prostate cancer. The researchers used data
from the Surveillance, Epidemiology, and End Results (SEER) Medicare
database, a population-based cancer registry encompassing approximately
14 percent of the U.S. population.
This study included data on 44,630 men age 65 to 80
years who were diagnosed between 1991-1999 with prostate cancer and who
had survived more than a year past diagnosis.
Patients were followed up until death or study end
(December 31, 2002). Patients were classified as having received
treatment (n = 32,022) if they had claims for radical prostatectomy or
radiation therapy during the first 6 months after diagnosis. They were
classified as having received observation (n = 12,608) if they did not
have claims for radical prostatectomy radiation or hormonal therapy.
Patients who received only hormonal therapy were
excluded.
The researchers found that patients who received
treatment had a 31 percent lower risk of death during the 12-years of
follow-up.
In the observation group, 4,643 patients died (37
percent) and 7,639 patients (23.8 percent) in the treatment group died.
Active treatment was associated with a significant
improvement in survival in the study overall. A benefit associated with
treatment was seen in all subgroups examined, including older men (age
75-80 years at diagnosis), black men, and men with low-risk disease.
“In summary, even though prostate cancer commonly
is considered an indolent [slow to develop and painless] disease, this
observational study suggests a reduced risk of mortality associated with
active treatment for low- and intermediate-risk prostate cancer in the
elderly Medicare population examined,” the authors write.
"Because observational data can never be free of
concerns about selection bias and confounding, these results must be
validated by rigorous randomized controlled trials of elderly men with
localized prostate cancer before the findings can be used to inform
treatment decisions.”
EDITORIAL: Treating older men with prostate
cancer — survival (or selection) of the fittest?
In an accompanying editorial, Mark S. Litwin, M.D.,
M.P.H., and David C. Miller, M.D., M.P.H., of the University of
California, Los Angeles, comment on the findings of Wong and colleagues.
“Improvement in the quality of care for men with
prostate cancer may best be achieved not by treating more patients but
by treating them more discerningly. Clinicians must remain steadfast in
their efforts to reduce over-treatment and under-treatment by
thoughtfully defining each patient’s unique balance between the natural
history of prostate cancer and that individual patient’s life
expectancy.”
“The reported association between treatment and
improved survival for older men with low- and intermediate-risk prostate
cancer will be confirmed or refuted by the results of ongoing randomized
controlled trials … Until then, physicians should apply these
provocative findings judiciously and continue their concerted efforts to
help patients make informed treatment decisions based not only on
survival predictions but also on health status, functional concerns,
and—most importantly—personal preference,” they write.
Note: article and editorial in December 13 issue of
JAMA.
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