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Co-morbidity, age, mortality, and early-stage prostate cancer

Posted Mar 03 2011 12:00am


New data from Peter Albertsen and his colleagues at the University of Connecticut have emphasized the importance of thorough assessment of the health status and co-morbidities of older men who are diagnosed with prostate cancer before making decisions about appropriate management.

Albertsen et al. carried out a sophisticated, 10-year-long “competing risk analysis” based on data from 19,639 men, all aged 66 years or older, all diagnosed with localized prostate cancer, and all of whom received no surgery or radiation within 180 days of diagnosis. The relevant data were identified through the use of the linked Surveillance, Epidemiology, and End Results (SEER) and Medicare databases.

Here are the key results from the study:

  • In the first 10 years after their diagnosis, men with moderately and poorly differentiated prostate cancer were more likely to die from something other than prostate cancer.
  • For men with clinical stage T1c disease, depending on patient age, Gleason score, and number of co-morbidities present at diagnosis

The authors conclude that, “Patients and clinicians should consider using comorbidity-specific data to estimate the threat posed by newly diagnosed localized prostate cancer and the threat posed by competing medical hazards.”

It is easy to make the claim that data like these reflect “ageism,” but what we are actually dealing with here are the realities of our own mortality. Some of us will live to 70; others will live to 105. Some of us will have the physical and mental capabilities of the average 65-year-old when we are 85; other will have the physical and mental capabilities of the average 105-year-old by the time we are 80. That’s real life. What is important in ensuring the highest possible quality of life for an individual patient is ensuring that we are offering the most appropriate care to that individual, not necessarily the latest technology.

“The older you get, the likelihood of benefiting from intervention becomes increasingly slim, because the risk of dying from prostate cancer becomes increasingly slim,” states Albertsen in a report from Reuters that also covers this new study.

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