Treating elderly men right after diagnosis is better than the current
'watchful waiting'

A New View on Prostate Cancer
Treating elderly men right after diagnosis is better than the current
'watchful waiting' approach, a study indicates.

By Thomas H. Maugh II, Times Staff Writer

Los Angeles Times
February 26 2006

It is better to treat prostate cancer in the elderly early on rather
than to wait and watch for signs of progression, as is now commonly
done, according to a new study that may change the care for many
patients with the deadly disorder.
Surgery or radiation therapy in elderly men increases survival by at
least 30%, raising median survival times from 10 years to more than 13
years, researchers reported Saturday at a prostate symposium in San
Francisco.
The finding in a study of about 49,000 men "challenges long-held beliefs
about prostate cancer treatment" by suggesting that treatment is better
than so-called watchful waiting, said Dr. Paul Lange of the University
of Washington, who did not participate in the study.
"It's a wonderful paper that validates what many of us have believed for
a long time," said Dr. Mark Kawachi, director of the prostate cancer
center at City of Hope National Medical Center in Duarte.
"Age, in and of itself, is not a definitive determinant of whether you
should be excluded from treatment" for prostate cancer, he said.
Prostate cancer is the most common type of cancer among men, with about
235,000 new cases diagnosed in the United States this year and about
27,000 deaths, according to the American Cancer Society.
It is primarily a disease of the elderly, with about two-thirds of those
afflicted over age 65.
But there is an "incredible controversy" over how to treat those older
patients, said Dr. Yu-Ning Wong of the Fox Chase Cancer Center in
Philadelphia, who led the new study.
Although it is clearly beneficial to treat younger men with the disease,
many oncologists put off treatment of older ones on the assumption that
most prostate cancers are slow growing. They reason that the afflicted
individual is likely to die from some other cause before the prostate
cancer becomes serious. Wong's study is the first to compare treatment
and no treatment in this age group. It is an observational study, so its
results cannot be considered definitive, but the findings should provide
guidance to physicians and patients who are unsure about how to proceed.
"There is a misconception that prostate cancer is universally an
innocuous disease of the elderly," said Dr. Howard Scher, chief of
genitourinary oncology at the Sloan-Kettering Memorial Cancer Center in
New York. With Wong's and other studies, "we are clearly seeing that is
not the case."
Wong's team studied Medicare records for 48,606 men age 65 to 80 who had
survived for a year after a prostate cancer diagnosis. All were
diagnosed between 1991 and 1999, with a median age of 72 at diagnosis.
A total of 19,948 men received radiation therapy, 14,098 underwent
surgery and the remaining 14,560 were simply observed.
Wong reported Saturday that 27% of the men in the watchful waiting group
were still alive, with a median survival time " the period in which half
the patients died  of 10 years. In contrast, 59% of those who received
either surgery or radiation therapy were still alive, with a median
survival time of 13 years and growing.
The benefit of treatment was apparent even among men who were 75 to 80
at the time of diagnosis.
Radiation and surgery seemed to be equally effective in all age groups,
she said.
The study results were "optimistic," she said. "It is nice to know that
what we have been doing for people is probably helping them."
Critics said the findings might be biased somewhat because the
researchers had no way of determining whether the prostate cancer
patients may have had some other medical problem that precluded
treatment for their cancer.
Wong said, however, that, even if allowance for the possibility of bias
is made, "there is clearly a survival advantage associated with
treatment."
Kawachi said the study did not examine the potential side effects and
complications of treatment, which may include urinary incontinence and
sexual dysfunction, among other things.
It's possible, he said, that some patients may live longer, but with a
diminished quality of life.
If the patient is excessively concerned about those potential
complications, "you have to wonder whether it is in the patient's best
interest to undergo treatment."
But, he said, as treatments improve and the risk of complications
diminishes, "then I think more of the older patient population can
appreciate and enjoy the survival advantage offered by treating prostate
cancer."
Full story Los Angeles times, Feb 26, 2006

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc