U.S. News and World Review, in their HealthDay section reported an interesting aspect of the continuing debate about treatment vs. “watchful waiting” (active surveillance). The article, written by Karen Pallarito “Rethinking Prostate Cancer in Older Men” suggests aggressive treatment is viable, even for patients in their late 70s!

Her premise, that increasing life expectancies, improved treatment options and better information on results, are allowing older men diagnosed with early prostate cancer to elect active treatment as opposed to active surveillance.
She was very clear that active surveillance does remain a viable option for men, especially older men, but according to Pallarito, many experts have changed their thinking and now believe that aggressive treatment — even for older men — may be the better way to go.

According to Dr. Edouard J. Trabulsi, assistant professor in the department of urology at Jefferson Medical College and co-director of the Jefferson Prostate Diagnostic Center in Philadelphia, “We’re pushing the limits on the upper end.”

A study published in the Journal of the American Medical Association has convinced many clinicians’ to modifying their thoughts on this issue. The study, which involved 44,000 men, found that the death risk for those who received prostate cancer treatment was nearly one-third lower than for men who received no treatment. This was true across all age categories, including the oldest men in the study, aged 75 to 80.

“We often think of prostate cancer as an indolent disease, and it is for many men, which is why observation is a very reasonable treatment option for patients with low and intermediate risk disease,” said the study’s lead author, Dr. Yu-Ning Wong, a medical oncologist at the Fox Chase Cancer Center in Philadelphia. “However, the life expectancy for a 70-year-old man is about 13 years, and patients who are otherwise healthy should recognize that if they live long enough, they may be at risk of developing complications from prostate cancer,” she added.

As men’s life expectancy gets higher and new, more effective treatment techniques are developed, the decision whether to treat or not is becoming more complicated.

According to a recent literature review published by the federal Agency for Healthcare Research and Quality, determining the best course of treatment is difficult. Their analysis concluded that there isn’t good data on the effectiveness and harms of treatments for clinically localized prostate cancer so they unfortunately concluded that men over 75 years old just should not be tested for prostate cancer. They basically recommended that we should just give up on men over 75 years and let them die a painful death from prostate cancer!

There is hope that better information on the benefits and risks of active surveillance compared with treatment, by late next year. The National Cancer Institute and the Department of Veterans Affairs are co-sponsoring a study, called the Prostate Cancer Intervention Versus Observation Trial, to compare radical prostatectomy — which is removal of the gland — and active surveillance on patient survival and overall quality of life.

We do not need more men, even older men, in our club of survivors of advanced prostate cancer. The guidelines propose by the Agency for Healthcare Research and Quality will only swell our ranks. No thanks, I would prefer we keep our club more exclusive.

Joel T Nowak MA, MSW