Prostate Cancer Therapy Not Best Choice For All Men

Prostate cancer treatment may be unnecessary in older men with other health issues

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When diagnosed with cancer, treatment may not always be the best option. Some older men with prostate cancer and several other health issues may opt not to treat their cancer.

Senior men diagnosed with prostate cancer in its early stages who were already dealing with other illnesses (co-morbidites) were more likely to die from those other problems than from the cancer, new research found.

"Ask your oncologist if aggressive prostate cancer treatment is right for you."

This study was led by Timothy Daskivich, MD, a University of California Robert Wood Johnson Fellow in Los Angeles.

The study included 140,563 men who were 66 years of age or older.

All of the men were diagnosed with early-stage prostate cancer between 1991 and 2007 and were part of the Surveillance, Epidemiology and End Results (SEER) Medicare database.

Information on co-morbidities were determined using claims made through Medicare in the 12 months prior to their cancer diagnosis.

The researchers then used the Charlson comorbidity index to figure out how likely the men were to die of other health issues.

The Charlson index predicts the likelihood of dying from health conditions within 10 years depending on the different illnesses a man might have and his age. Charlson scores are 0, 1, 2 or 3 and higher. A person aged 40 with diabetes that is easily controlled with oral medication might have a Charlson score of 1, for example. Someone 67 years of age with both insulin-dependent diabetes and chronic obstructive pulmonary disease (a serious, progressive disease that makes it hard to breathe) would have a score of 3 or higher. The higher score means that person is more likely to die within 10 years than someone with a lower score who is generally healthier.

The men in the study were followed for 15 years.

Men who had scores of 0, 1 or 2 on the Charlson index, meaning they did not have many other serious health issues, had a better chance of living longer if they were aggressively treated for their prostate cancer. Aggressive treatment includes therapy such as radiation or surgery.

Overall, among men with a Charlson score of 0, the risk of dying from cancer within 15 years was 6.1 percent lower in those treated aggressively than in those who were not treated aggressively. In men with a Charlson score of 3 or higher, the difference was only 0.09 percent.

Men with a Charlson score of 3 or more who had aggressive treatment were not likely to live any longer than men with similar scores who were not treated for their prostate cancer, the study authors reported. These older men with multiple other health problems were more likely to die from their comorbidities, the authors concluded.

In addition, the treatment for prostate cancer often has negative effects, the study authors noted, such as impotence, urinary incontinence and bowel dysfunction.

"In the past, we've relied on the basic argument that older and sicker men are much more likely to die of other things besides their prostate cancer, “ Dr. Daskivich said in a press release. "Now we've shown that aggressive treatment of these men is ineffective. This information will help these men better maximize the quality of their remaining years."

"This elegant large population-based study adds further evidence demonstrating the effectiveness (increased prostate cancer-specific survival) of both radiation therapy and prostatectomy for men with low and intermediate risk prostate cancer," said Brian D. Lawenda, MD, clinical director of Radiation Oncology at 21st Century Oncology in Las Vegas.

"However, not unexpectedly, when this data was analyzed based on competing health problems (i.e., heart disease, lung disease, other cancers, etc.), those men with the highest risk of dying from these other conditions were also less likely to benefit from aggressive treatment to the prostate," he said.

"Most physicians already intuitively know that their patients with serious medical co-morbidities are at a greater risk of dying from those health problems rather [than] from low and intermediate risk prostate cancer. Nevertheless this study provides concrete, data-driven evidence that may be helpful for patients and their providers when making treatment decisions," Dr. Lawenda told dailyRx News.

This study was published online on May 13 in Cancer.

One of the study’s authors, Dr. Christopher Saigal, acknowledged that he is cofounder of Wiser Care, LLC. The other authors had nothing to disclose.

Review Date: 
May 14, 2014
Last Updated:
May 15, 2014