Should treatments offered to older men with high risk prostate cancer be different than for younger men? Researchers from the University of California, San Francisco found that older men were denied more aggressive treatments because of their age. Men older than 75 years of age with high-risk prostate cancer often are under-treated when compared to their younger peers. Many older men were only offered hormone therapy or watchful waiting alone, instead of more aggressive treatments such as surgery and radiation therapies.

The researchers stated that their findings indicated that age is a barrier to treatments that could cure prostate cancer. The researchers concluded that the failure to use more aggressive treatment results in their earlier death. Are we putting men on an ice flow and just sending them out to sea to die?

“There is a disconnect between risk and treatment decisions among older men,” said senior investigator Matthew R. Cooperberg, MD, MPH. “Patient age is strongly influencing treatment decisions, so we sought to understand whether age plays a role in risk of the disease and survival. We found that under-treatment of older men with high-risk disease might in part explain higher rates of cancer mortality in this group. There is also pervasive over treatment of low-risk disease in this age group. Overall, treatment needs to be selected more based on disease risk and less based on chronological age.”

The researchers analyzed data from the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database. After reviewing the data base which included 13,805 men they concluded that older men are more likely to have high-risk prostate cancer at the point of diagnosis and less likely to receive potentially curative local therapy. Yet when older, high-risk men received more aggressive treatment, they had a 46% lower death rate than men treated more conservatively with hormonal therapy or watchful waiting.

I guess that we do have the equivalent to ice flows and that we feel free to decide who should live and who should die. If you are over 75 years your live is not worth as much as a man who is 70, or 60. Where is the respect that should be given to our older citizens, the people who fought for us in World War II and Korea? Where is the reverence for those individuals who paved the way for our current life style? These are our fathers and grandfathers, isn’t there a value in their lives?

Journal of Clinical Oncology (2011; 29:235-41).

Joel T Nowak, M.A., M.S.W.