UCLA researchers found that a significant number of men suffering from prostate cancer who are older than 66 years, have life expectancies lower than 10 years, but still, half of them are still over-treated with surgery, radiation or brachytherapy.
Even though national guidelines recommend that radiation therapy or surgery should not be given to men who are diagnosed with low and intermediate risk prostate cancer (or who have less than 10 years of life expectancy), the study found that a significant percentage of those men are actually receiving aggressive procedures, resulting in potentially incapacitating side effects.
The study, published in Cancer, relied on the Surveillance, Epidemiology and End Results (SEER) Medicare database to analyze 96,032 men aged 66 and older, diagnosed with early-stage prostate cancer from 1991 to 2007.
Based on the available data, researchers were able to calculate patients’ life expectancy and understand which treatment patterns were applied in men who had less than 10 years of life expectancy.
“Life expectancy is poorly integrated into treatment decision-making for prostate cancer, yet it is one of the primary determinants of whether a patient will benefit from treatment with surgery or radiation,”study first author Dr. Timothy Daskivich, a UCLA Robert Wood Johnson fellow said in a news release. “Because these treatments have side effects such as erectile dysfunction, urinary incontinence and bowel problems, it’s critical for men with limited life expectancies to avoid unnecessary treatment for low- and intermediate-risk prostate cancer”, he added.
The team found that 68% of the time, men aged 66 to 69 were treated aggressively with radiation, surgery or brachytherapy; 69% of the time, men aged 70 to 74 received aggressive treatment; and 24% of the time men older than 80 years were aggressively treated.
“Describing treatment trends by both age and health status is key, because younger, sicker men may have life expectancies of less than 10 years, while older, healthier men may have life expectancies longer than 10 years,” Dr. Daskivich explained. “This information will help men with newly diagnosed low- and intermediate-risk prostate cancer understand their likelihood of living long enough to benefit from aggressive treatment. It will also raise awareness among clinicians that a large number of men older than 65 are at risk for having life expectancies of less than 10 years. Hopefully, these results will promote integration of this information into treatment decision-making discussions”.
The team now wants to assess whether these results will have an impact in treatment decision-making for men with prostate cancer, and if the tendency to over-treat this group of patients will continue.