The advice to detect and treat cancers at the first opportunity may not apply to older men with prostate tumors, according to the latest study.
With a government-backed group advising that most men no longer need regular screening for prostate cancer with the prostate-specific antigen (PSA) blood test, researchers now say that older men who are diagnosed with the disease should not always get surgery or radiation treatment.
That’s because for most men, having a low to moderate risk of prostate cancer is not a major red flag for early death. The cancer is typically so slow-growing, that many of these men will die from other causes, which means the benefits of treatment do not always outweigh the risks. Surgery, radiation and radioactive seed implants can cause disorders such as erectile dysfunction and urinary incontinence. And since it can take many years for the effects of the treatments to emerge, the survival advantage is low in most cases in which the tumors aren’t aggressive.
In the new study, published in the journal Annals of Internal Medicine, led by researchers at the University of California Los Angeles (UCLA) Department of Urology looked at the 14-year survival of 3,000 men diagnosed with prostate cancer between the years 1994 and 1995. Older men with low to intermediate cases of prostate cancer, who also had at least three other health problems like diabetes, hypertension, congestive heart failure and arthritis, were significantly more likely to die from a cause unrelated to their cancer.
The 10-year risk of dying from these other causes among men aged 61 to 74 was 40%, and for men over 75, it climbed to 71%. The 14-year risk of dying from low or intermediate risk prostate cancer was 3% for men between 61 and 74, and 7% among men over 75. For men with high-risk prostate cancer, the risk of death from the cancer was 18% at the 14-year mark.
Watchful waiting is a common strategy for treating prostate cancer, since in about 40% of cases the tumors are so slow-growing that they don’t require additional, invasive biopsies or treatment and men with the cancer are more likely to die of other causes.
But based on analyses of tissue from men whose prostates were surgically removed as a precaution even if they were deemed to be low-risk, anywhere from 15% to 20% of these low-risk cases actually turn out to involve tumors that were more aggressive. As a result, the tumors were mischaracterized by available predictive methods such as the blood-based prostate specific antigen (PSA) test and imaging to search for hidden growths.
As these types of tests become more available, it may be possible to help more men avoid unnecessary surgery, and the complications that could come along with those procedures, say the study authors. The added information should also help patients with peace of mind in knowing that their “watching waiting” strategy is the right one, as contrary as it may seem when it comes to cancer.
, reports that older prostate cancer patients, who have other underlying health conditions, should reconsider undergoing surgical or radiation treatments for prostate cancer.