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Does prostate cancer treatment help older, sick men?

By Andrew M. Seaman

NEW YORK (Reuters Health) - Older men with other illnesses may not live long enough to benefit from aggressive prostate cancer treatments, such as prostate removal or radiation, and they'd have to live with their side effects, says a new study.

"If you're going to die of a heart attack in five years, what's the point of going through radiation?" asked Dr. David Penson, the study's senior author from the Vanderbilt University Medical Center in Nashville, Tennessee.

"The key point is that when men are choosing therapy for prostate cancer, they need to consider their tumor characteristics, their age and other characteristics," he said.

About one man in every six will be diagnosed with prostate cancer during his lifetime, according the American Cancer Society (ACS). While it can be a serious disease, the ACS says most men don't die from the slow-moving cancer.

Still, many choose to have surgery and/or radiation to treat the cancer, even though it can lead to side effects that impact quality of life, including erectile dysfunction, incontinence and other problems (see Reuters Health article of June 27, 2012: http://reut.rs/MpPr4t.)

As an alternative to surgery and radiation, some doctors recommend so-called active surveillance, also known as watchful waiting.

For the new study published in the Annals of Internal Medicine on Monday, Penson and his colleagues used data from a national database to see what effects age, other illnesses and tumor characteristics had on risk of death from cancer and other conditions.

The researchers included men between the ages 39 to 89 years old who were diagnosed with early-stage prostate cancer between October 1994 and October 1995.

They collected information on the men's other conditions - including diabetes, heart problems, and strokes - and tracked them through the database over 14 years.

Over that time, the researchers found the risk of dying from high-risk prostate cancer was 18 percent. The risk of dying from low-risk prostate cancer was 3 percent and 7 percent for high-risk disease.

Older men were more likely to die from something else during the 10 years following diagnosis if they had other ailments.

For example, about 40 percent of men between the ages of 61 and 74 years old died within the 10 years after their prostate cancer diagnosis if they had three or more comorbidities, compared to 71 percent of men 75 years old and older.

WEIGHING OPTIONS

"This is just the type of study we need at this time to help us determine who will and will not benefit from treatment," said Dr. H. Ballentine Carter, a urologist and oncologist at Johns Hopkins School of Medicine in Baltimore.

But Carter, who was not involved with the new study, told Reuters Health it's important to look at each individual patient.

"For that (75-year-old) guy who has no comorbidities or few, he may be more likely to benefit from treatment than the 60-year-old who has a low-grade tumor and multiple comorbidities," he said.

"The challenge for the physician is to accurately evaluate the life expectancy of a patient in order to balance the risk for prostate cancer mortality with that of other-cause mortality," wrote Italian Drs. Lazzaro Repetto, Angela Marie Abbatecola and Giuseppe Paolisso in an editorial accompanying the study.

Penson and his colleagues, caution however, that their results shouldn't be used to decide whether or not a person should be screened for prostate cancer.

Currently the U.S. Preventive Services Task Force, a government-backed panel, recommends against prostate cancer screening for average-risk men of all ages.

Earlier this month, the American Urological Association made news when they recommended against screening average-risk men under age 55 or any man over 70 using prostate-specific antigen, or PSA, blood tests (see Reuters Health article of May 3, 2013 here: http://reut.rs/13FUGEe.)

SOURCE: http://bit.ly/Zwi3u5 Annals of Internal Medicine, online May 20, 2013.

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