Hold Your Horses, Older Men!

Prostate cancer less likely to cause death in older men than underlying conditions

(RxWiki News) One of the challenges of managing prostate cancer is measuring how aggressive it is. Because a man is diagnosed with prostate cancer doesn’t necessarily mean it needs to be treated.

New research findings may make treatment decisions easier for men over the age of 60.

Older men, particularly those with underlying conditions such as heart disease or diabetes, need to think carefully about treating prostate cancer at all.

These gentlemen may not want to undergo treatment because their other conditions (co-morbidities) are more likely to cause death than the prostate cancer. 

"Have your doctor explain why tests are needed."

Timothy Daskivich, MD, a University of California Los Angeles (UCLA) Robert Wood Johnson fellow, led the research effort that looked at the 14-year survival rates of prostate cancer patients diagnosed between 1994 and 1995.

"The take home point from this study is that older men with multiple underlying health problems should carefully consider whether they should treat these tumors aggressively, because that treatment comes with a price," said Dr. Daskivich in a prepared statement.

Prostate cancer treatment (surgery, radiation and hormone therapy) can cause major physical problems, including urinary and bowel control problems and sexual dysfunction.

Prostate cancer expert and researcher, E. David Crawford, MD, told dailyRx News these findings aren’t really new. “Much of the current controversy regarding screening for prostate cancer stems from determining who will benefit."

"Rather than be faced with the dilemma of treating a man with co-morbidities, he should not have been screened to begin with,” said Dr. Crawford, professor of surgery, urology and radiation oncology and head of the Section of Urologic Oncology at the University of Colorado Health Sciences Center (UCHSC) in Denver.

For this study, a total 3,183 men with prostate cancer that had not begun to spread (metastasize), filled out questionnaires six months after their diagnosis. The men were asked to describe what type of cancer treatment they’d undergone and what other conditions they had.

The researchers focused on older men who had three of more co-morbidities, such as high blood pressure (hypertension), arthritis, congestive heart failure and liver disease.

After 14 years of follow-up, the study found the following results for men with low- to moderate-risk prostate cancer:

  • The risk of dying from something other than prostate cancer over a 10-year period was 40 percent for men aged 61 to 74.
  • For men over the age of 75, the risks of dying from other co-morbidities was 71 percent.
  • The risk of dying from prostate cancer was 3 percent for men between the ages of 61 and 74 and 7 percent for men over the age of 75.
  • For men with high-risk prostate cancer, the risk of dying from the disease was 18 percent over 14 years, which did not vary by number of co-morbidities.

Dr. Crawford led a study first published in 2010 in the Journal of Clinical Oncology that he said found “...that the only men who benefit from early detection are those with no co-morbidities.”

"If you're very unlikely to benefit from treatment, then don't run the risk and end up dealing with side effects that can significantly impact quality of life," Dr. Daskivich said. "It's important for these men to talk to their doctors about the possibility of forgoing aggressive treatment.”

Dr. Daskivich added, “We're not talking about restricting care, but the patient should be fully informed about their likelihood of surviving long enough to benefit from treatment."

This study was published May 20 in Annals of Internal Medicine. The National Cancer Institute funded this study.

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Review Date: 
May 20, 2013