A new study led by researchers at the Rutgers Cancer Institute of New Jersey was recently published in the journal European Urology revealing that elderly patients with low-risk prostate cancer can benefit in terms of survival from conservative management of the disease. The study is entitled “Fifteen-year Outcomes Following Conservative Management Among Men Aged 65 Years or Older with Localized Prostate Cancer.”
Prostate cancer is the second most common cancer in men, with almost one million new cases diagnosed every year worldwide. It was previously shown that men who were diagnosed with prostate cancer in the early 90s had a higher 10-year survival rate in comparison with men whose cancers were diagnosed in prior decades. This study has now been extended to a follow-up period of 15 years, and evaluated survival rates among older men diagnosed with localized prostate cancer that have been submitted to conservative management.
The team conducted a population-based study with 31,137 Medicare patients aged 65 or older who had been diagnosed with early-stage localized prostate cancer between 1992 and 2009, and who had only received conservative management in the first six months after diagnosis. Conservative management is based on patient’s close monitoring and excludes surgery, radiotherapy, androgen deprivation therapy or cryotherapy.
Prostate cancers can be classified using the Gleason score, a grading system that helps to evaluate cancer prognosis based on its microscopic appearance, where a higher Gleason score corresponds to a more aggressive cancer with a poor prognosis. The research team found that men aged between 65 and 74 years with prostate cancer of Gleason score 5-7 (treatable cancer) had a lower 15-year risk of prostate cancer-specific mortality (5.7%) than patients with a Gleason score cancer of 8-10 (unlikely to be cured), who had a higher 15-year risk of dying from prostate cancer (22%), which increased with age (for men aged 75 and older, the risk increased to 27%). Researchers also found that the mortality rates remained relatively stable from 6 to 16 years following diagnosis.
The research team concluded that the 15-year survival outcome upon conservative management is excellent in men aged 65 or older with Gleason 5-7 prostate cancer score. Patients with prostate cancer of Gleason 8-10 who have been managed conservatively however, have a higher mortality associated with the disease. The findings support the idea that conservative management is a reasonable choice for elderly patients diagnosed with low-grade localized prostate cancer.
“In weighing whether treatment benefits outweigh the risks, radical prostatectomy — for instance — is typically not recommended for older men with low-grade disease. But many elderly patients are treated with radiotherapy or hormonal therapy even if their cancer is indolent, so that they can feel like they are doing something,” explained the study’s lead author Dr. Lu-Yao in a news release. “By having additional data available to support conservative management, doctors can further educate their patients about survival outcomes and possibly help avoid treatments that may put the patient at risk.”
“The proportion of men diagnosed with localized prostate cancer who choose to have conservative management is relatively small but, is on the rise. The information provided by this long-term study will help facilitate treatment decisions,” concluded Dr. Lu-Yao.