Healthy, Older Men Live Longer With Aggressive Prostate Cancer Treatment so we should provide treatment.
The US Preventive Task Force (USPTF) report which has caused huge amounts of debate in the prostate cancer community, especially surrounding the continuation of PSA testing and providing treatment for prostate cancer in older men has taken a good and well deserved beating from a report from Researchers at Brigham and Women’s Hospital (BWH) (Boston Ma). They have found that older men, who are otherwise healthy, benefit from aggressive treatment for unfavorable-risk prostate cancer, this flies directly in the face of the report from the USPTF which says that older men should not be screened for prostate cancer. Many of us feel that in reality the USPTF has recommended that older men should just be placed on an ice flow and sent out to sea to die. This is an obnoxious conclusion that must be countered now.
These findings from BWH are published online and in an upcoming print issue of the International Journal of Radiation Oncology, Biology Physics.
“When the US Preventive Services Task Force recommended against PSA screening for any man over 75 years old, it gave some people the impression that it isn’t worthwhile to either find or treat prostate cancer in older men. However, our study found that if an older man is diagnosed with unfavorable-risk prostate cancer, aggressive treatment can improve his chances of surviving, just as it does for younger men, provided that he is otherwise relatively healthy,” said Paul L. Nguyen, MD, a radiation oncologist at the Dana-Farber/Brigham and Women’s Cancer Center. “This tells us that it’s not just age alone, but also overall health status that must be considered when deciding whether or not to aggressively treat men with prostate cancer.”
In this study, researchers reanalyzed a randomized trial comparing radiation therapy plus hormone therapy versus radiation therapy alone for men with clinically localized unfavorable-risk prostate cancer (such as Gleason score 7 or higher, or PSA >10). The original trial had shown that patients who were randomized to a combination of radiation and hormones lived longer than those randomized to radiation alone. In this reanalysis, researchers focused on the subgroup of 7820 men who were older than the median age of 72.4 yrs and found that those over the median age also obtained a significant survival benefit with more aggressive treatment as long as they were otherwise healthy, or had little to no other health issues (comorbidities), aside from their prostate cancer. They also found that older men who had some or many additional health issues, did not benefit from the more aggressive treatment.
The researchers have concluded, “As clinicians, we must not use strict age cutoffs when deciding which patients should be treated aggressively. We must evaluate the entire patient including his age, additional health issues and longevity,” said Nguyen.
Older men should insist that they continue to be given regular PSA tests as well as DRE exams. If they are found to have prostate cancer, especially aggressive disease, they need to press their doctors, especially if they are otherwise healthy for full treatment. It will extend your life.
Joel T Nowak MA, MSW