Treat Prostate Cancer in Older Men?

To treat or not to treat? That is the question for older men with early-stage prostate cancer.

The jury is still out, but new research suggests a survival advantage for older prostate cancer patients with localized disease who chose active treatment over close observation without treatment, known as watchful waiting.

The look-back study included data from nearly 45,000 patients between the ages of 65 and 80 with low- to intermediate-risk prostate cancer.

Over 12 years of follow-up, patients treated with either surgery or radiation were found to have a 31 percent lower risk of death than patients who did not opt for treatment.

The National Institutes of Health-funded trial is published in the Dec. 13 issue of The Journal of the American Medical Association.

"Our findings suggest that there may be a [survival] benefit associated with treating older patients with early-stage disease," researcher Yu-Ning Wong, M.D., of Philadelphia's Fox Chase Cancer Center, tells WebMD.

"While treatment is clearly not the right decision for every patient, the potential for a survival advantage should enter into the decision making."

Ongoing Trials

The latest findings appear to contradict a large Scandinavian trial, published last year, which directly compared prostate cancer surgery to watchful waiting. In that trial, the treatment-related survival advantage was largely confined to men under the age of 65.

Two other large trials directly comparing treatment to nontreatment are under way, one in the U.S. and the other in the U.K. Results from these trials are expected before the end of the decade.

UCLA urology and public health professor Mark S. Litwin, M.D., M.P.H., says these trials should help clarify the issue of who needs treatment and who doesn't.

He tells WebMD that the study by Wong and colleagues, while very well done, falls short of proving that older prostate cancer patients derive a survival advantage with treatment.

This study should not be seen as a foot on the accelerator for the treatment of these patients, he says. "It is provocative and encouraging. But at the end of the day it is still an observational study, and the ultimate answer has to come from randomized, control trials."

Quality of Life

In an editorial accompanying the study, Litwin and colleague David C. Miller, M.D., M.P.H., wrote that quality-of-life considerations must be factored into any decision about the treatment of early-stage prostate cancer.

Impotence, urinary incontinence, and bowel problems are all potential side effects of the most widely used treatments for prostate cancer.

They noted that while the newly published study did show a survival advantage for treated patients, little difference was seen in disease-specific survival between the two groups. During the 12 years of follow-up, 8% of treated patients and 6.8 percent of untreated patients died of prostate cancer.

Litwin tells WebMD that decisions about how to manage early-stage prostate cancer must be made on a case-by-case basis, and this is especially true for older men with the disease.

"The older a patient is, the more circumspect one ought to be before marching ahead with a treatment that can have a significant impact on quality of life," Litwin tells WebMD.

SOURCES: Wong, Y-N. The Journal of the American Medical Association, Dec. 13, 2006; vol 296: pp 2683-2693. Yu-Ning Wong, M.D., division of population science and medical science, Fox Chase Cancer Center, Philadelphia. Mark S. Litwin, M.D., M.P.H., professor of urology and public health, University of California at Los Angeles.