Whether or not to treat prostate cancer in older men is a dilemma, particularly when the cancer is of low or intermediate risk and hasn’t spread beyond the prostate. Now, findings from a new study suggest that surgical or radiation treatment in these cases increases survival compared with waiting to see if the disease worsens.
"The optimal management of localized prostate cancer is controversial," researcher Dr. Yu-Ning Wong told Reuters Health. She agrees that because of its slow-growing nature, prostate cancer is often thought of as a "disease a man dies with, not from." However, whether treatment offers any survival advantage over careful monitoring is unclear due to "limited data available from randomized controlled trials."
The present study involved an analysis of data for 44,630 men who were diagnosed with localized prostate cancer at 65 to 80 years of age and were entered in a Medicare database.
Wong, from the Fox Chase Cancer Center in Philadelphia, noted that 32,022 received treatment and 12,608 were managed by ‘watchful waiting’ to see if treatment became necessary.
During 12 years of follow-up, the mortality rates in the treatment and observation groups were 24 percent and 37 percent, respectively, Wong and colleagues report in this week’s Journal of the American Medical Association.
Treatment was associated with significantly higher rates of survival at 5 years and 10 years, the report indicates.
After adjustment for other factors, such as tumor characteristics and other illnesses, treatment reduced the risk of dying by 31 percent, the findings show.
"Our data show that there may be a survival advantage in treating these patients," but the findings should be verified in a randomized trial, Wong said. Two such trials are currently underway and the results could be available as early as 2009, she added.
