To Treat or not to Treat Prostate Cancer in Older Men
A study by researchers from the University of California at Los Angeles reported December 5, 2014 in UCLA News that more than half of men age 66 and older were being over-treated for prostate cancer, contrary to Guidelines from the American Urological association, National comprehensive Cancer Network and the European Association of Urology. These guidelines recommend that early stage prostate cancer be managed conservatively in patients who are expected to live for less than 10 more years. The study was published December 1, 2014 in the journal Cancer.
Many early stage cancers are found to be very slow-growing and also many men over the age of 70 have other medical conditions that could potentially shorten their lives, so a “watchful waiting” approach is recommended where the cancer is monitored very closely, but is not treated. However, the study discovered that many of these older men were being over-treated aggressively for prostate cancer, even though they were expected to die before the cancer could reach a dangerous state or before the treatments would show any benefit. In fact, even men who had other serious medical conditions that could shorten their lives were also receiving aggressive unnecessary treatment such as:
- External Beam Radiotherapy
- Brachytherapy implants radioactive seeds in the prostate gland.
- Surgery to remove the prostate gland
Life Expectancy not Taken into Enough Consideration when Deciding about Treatment
According to lead author Dr. Timothy Daskivich, these men were being over-treated without any concern for their quality of life. He said that life expectancy is not taken into enough consideration in making decisions about treatment, even though life expectancy is one of the main factors that determine whether a patient will benefit from treatment by radiation or surgery.
Dangerous and Debilitating Side Effects
The study showed that many of these men experienced dangerous and debilitating side effects from these aggressive treatments that were also having a very bad effect on the quality of their lives such as serious urinary and bowel problems and more. The researchers concluded that radiation and surgery did not improve survival but caused very bad side effects.
The Surveillance, Epidemiology and End results (SEER) Medicare Data Base Study
The researchers gathered information from The Surveillance, Epidemiology and End Results (SEER) Medicare Data Base Study from 1991 to 2007 on 96,032 men aged 66 and older, who had been diagnosed with early-stage prostate cancer. The researchers divided them into four groups based on life expectancy of less than 10 years:
- Men aged 66-69 were aggressively treated with radiation, surgery or radioactive seed implants 68% of the time.
- Men aged 70-74 were aggressively treated 69% of the time.
- Men aged 75-79 were aggressively treated 57% of the time.
- Men 80 and older were aggressively treated 24% of the time.
Testing for Prostate Cancer
Testing for prostate cancer can also lead to side effects. The CDC shares a video called “Should I get Tested for Prostate Cancer?”
Prostate cancer is the second most commonly found cancer among men in the United States. According to the Centers for Disease Control and Prevention (CDC), in 2015 there were 183,529 new cases of prostate cancer and 28,848 men died of prostate cancer in the United States. Cancer is the second leading cause of death in the United States after heart disease. One of every four deaths in the United States is due to cancer.
Rehabilitation after Cancer Treatment or Surgery
If you or your loved one are in need of rehabilitation cancer treatment or surgery in the Syracuse, NY area the Van Duyn Center for Rehabilitation and Nursing offers expert short-term rehabilitation and long-term skilled nursing.
Men should discuss with their doctor about whether they should take a wait and see approach to their prostate cancer or whether it pays to treat it aggressively.