Are we (still) over-treating older men with localized prostate cancer?
Posted Mar 15 2011 12:00am
There is good reason to believe that a very high percentage of older men particularly those over 75 years with low-risk prostate cancer who have a life expectancy of 10 years or less will get little to no clinical or survival benefit from active therapeutic intervention (although they should clearly be carefully monitored and given all appropriate care).
However, it is also recognized that a high percentage of such men do, in fact, receive active therapeutic intervention.
Roberts et al. decided to conduct a structured analysis of the impact of clinical and non-clinical factors on the selection of active therapy for patients of 75 years and older who were newly diagnosed with localized prostate cancer in 2004 and 2005. To do this, they used data from the linked, population-based Surveillance, Epidemiology, and End Results (SEER) and Medicare databases. Active therapies included radical prostatectomy, external beam radiation therapy, brachytherapy, and/or androgen deprivation therapy.
The researchers were able to demonstrate the following:
In total, 81.7 percent of men of 75 years and older were treated with active therapy.
The application of active therapy varied by level of risk.
The overall impact of clinical and non-clinical factors on the decision to treat was minimal at 5.1 and 2.6 percent, respectively.
In men with low-risk disease, comorbidity status did not significantly affect treatment selection.
Geographic location was the most powerful predictor of treatment selection (Northeast vs Greater California: OR = 2.41).
The authors conclude that, as of 2004/5, “Clinical factors play a limited role in treatment selection among elderly patients with localized prostate cancer.”
Whether we would see the same level of active treatment of men of 75 years and older today is perhaps open to question. In the past few years there has been much greater emphasis placed on the use of active surveillance in the management of men with a limited life expectancy and low-risk disease. However, it may be 5 years before we can obtain sufficient data from the SEER-Medicare linked database to establish whether there was a really significant increase in the use of surveillance as a method to manage low-risk prostate cancer in older men between 2005 and 2011.
There is good reason to believe that a very high percentage of older men particularly those over 75 years with low-risk prostate cancer who have a life expectancy of 10 years or less will get little to no clinical or survival benefit from active therapeutic intervention (although they should clearly be carefully monitored and given all appropriate care).
However, it is also recognized that a high percentage of such men do, in fact, receive active therapeutic intervention.
Roberts et al. decided to conduct a structured analysis of the impact of clinical and non-clinical factors on the selection of active therapy for patients of 75 years and older who were newly diagnosed with localized prostate cancer in 2004 and 2005. To do this, they used data from the linked, population-based Surveillance, Epidemiology, and End Results (SEER) and Medicare databases. Active therapies included radical prostatectomy, external beam radiation therapy, brachytherapy, and/or androgen deprivation therapy.
The researchers were able to demonstrate the following:
The authors conclude that, as of 2004/5, “Clinical factors play a limited role in treatment selection among elderly patients with localized prostate cancer.”
Whether we would see the same level of active treatment of men of 75 years and older today is perhaps open to question. In the past few years there has been much greater emphasis placed on the use of active surveillance in the management of men with a limited life expectancy and low-risk disease. However, it may be 5 years before we can obtain sufficient data from the SEER-Medicare linked database to establish whether there was a really significant increase in the use of surveillance as a method to manage low-risk prostate cancer in older men between 2005 and 2011.