Prostate cancer does not always have to be treated. If it’s slow growing, active surveillance may be the best course. For older men who have other conditions, prostate cancer probably ought to be left alone.
Men who are older and have a short life expectancy may do well to refuse treatment for less aggressive prostate cancers.
The disease is not likely to cause additional problems, while treatment could severely impact quality of life.
Researchers at Yale University have come to this conclusion after analyzing nine years of Medicare data.
“Treatment can do more harm than good in some instances,” said senior author on the study Cary Gross, M.D., associate professor of internal medicine at Yale School of Medicine.
“Among men who are older and have less aggressive forms of prostate cancer, their cancer is unlikely to progress or cause them harm in their remaining years.”
Dr. Gross and colleagues found in their research of 39,270 men aged 67 and older that curative prostate cancer treatment has been increasing over the past decade.
Researchers found that treatment for men in this age group increased from 61.2 to 67.6 percent between 1998 and 2007. Dr. Gross, who is a member of the Yale Cancer Center, found the largest increases among men with moderate-risk disease who had the shortest life expectancy.
During this same period, prostate cancer treatment decreased among men with longer life expectancies and low-risk disease.
Dr. Gross notes that not treating prostate cancer that could be fatal would demonstrate poor quality care. However, aggressively managing disease that’s not likely to get worse exposes patients to complications such as impotence and incontinence and serves only to increase medical costs.
Active surveillance is what the National Comprehensive Cancer Network practice guidelines in oncology recommend for men who fall into this category.
“Future work should explore how better to incorporate both cancer characteristics and patient life expectancy into decision making,” Dr. Gross said.
A report on this study was published in the February 27, 2012 issue of Archives of Internal Medicine.
This research was funded by the National Cancer Institute and the James G. Hirsch Medical Student Research Fellowship.
Each year in the United States, over 200,000 men will be diagnosed with prostate cancer. Unfortunately, 32,000 of them will succumb to the disease, making it the third most common cause of death from cancer in men of all ages and the most common cause of death from cancer in men over age 75. However, due to improved detection and treatment, there are over 2 million men in the United States who are currently prostate cancer survivors.
The prostate is a small, walnut sized organ in men that sits below the bladder and is responsible for making seminal fluid, which is necessary for ejaculation and fertility. Symptoms of prostate cancer closely resemble those of benign prostatic hypertrophy, with delayed or slowed initiation of urination, dribbling and leaking of urine, a slow urinary stream, and incomplete emptying of the bladder. Blood may be present in the urine or semen as well. Pain in the bones of the lower back and pelvis may be a sign that prostate cancer has spread.