Treating Prostate Cancer in Elderly Men Extends Lives Compared to
"Watchful Waiting"

" We found that men with early stage and low- or intermediate-risk
prostate cancer who underwent active treatment with either radical
prostatectomy or radiation therapy within 6 months after diagnosis were
30% less likely to die during the subsequent 12 years of follow-up than
men who did not undergo active treatment within 6 months after
diagnosis." Yu-Ning Wong.

December 13, 2006 -- Elderly men who received treatment for localized
prostate cancer survived significantly longer than men who did not
receive treatment, according to a study in the December 13 issue of
JAMA.

Yu-Ning Wong, M.D., of the Fox Chase Cancer Center, Philadelphia, and
colleagues compared outcomes from 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.

The study gathered Medicare records data for 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 if they had
Medicare claims for radical prostatectomy or radiation therapy during
the first 6 months after diagnosis. They were classified as having
received observation if they did not have claims for radical
prostatectomy radiation or hormonal therapy. Patients who received only
hormonal therapy were excluded.

A total of 111, 640 men between 65 and 80 years of age who had been
diagnoised with prostate cancer diagnosis between 1991 and 1999 were
included in the study. Of these men, 32,022 men were classified as
receiving treatment while 12,608 were classified as untreated,
"observation" group.

Results showed that patients who received treatment had a 31 percent
lower risk of death during the 12-years of follow-up. In the untreated,
observation group, 37 percent died while in the treatment group only
23.8 percent 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 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. 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," the authors write.

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 overtreatment and undertreatment 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.

Full text of the JAMA article is available online, free, at:
http://jama.ama-assn.org/cgi/content/full/296/22/2683
 

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