THE "NEW" PROSTATE CANCER INFOLINK

A new study just published in the Journal of General Internal Medicine makes a strong case for the importance of individualized application of specific treatments to older men diagnosed with prostate cancer — something which you would think ought to be evident to the majority of clinicians, but apparently wasn’t in two hospitals in Los Angeles between 1997 and 2004.

Chamie et al. carried out a careful retrospective analysis of data from of 1,031 U.S. military veterans, all diagnosed with non-metastatic prostate cancer between 1997 and 2004 at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers. The patients were all followed until 2010.

Here are their basic findings:

• About two-thirds of the patients were given aggressive, first-line treatment for their prostate cancer.
• About a quarter of men aged 75 were given aggressive, first-line treatment for their prostate cancer, although their chance of living another 10 years was 58 percent on average.
• Estimated rates of non-prostate cancer-specific mortality at 10 years of follow-up were
• 16 percent among men with no other co-morbid conditions
• 35 percent among diabetics without end-organ damage
• 49 percent among men with peripheral vascular disease
• 65 percent among men with moderate-to-severe chronic obstructive pulmonary disease (COPD)
• 50 percent among diabetics with end-organ damage
• Compared with subjects with no other co-morbid conditions at all, only patients with moderate-to-severe  COPD were less likely to receive definitive treatment for their prostate cancer (RR = 0.74).
• Men with all other individual co-morbidities were equally likely as men without co-morbidity to receive definitive treatment for their prostate cancer.
• Men with a number of specific co-morbid conditions had a higher hazard ratio (HR) for non-prostate cancer-specific mortality; those conditions included
• Diabetes without end-organ damage (HR = 2.32)
• Peripheral vascular disease (HR = 2.77)
• Moderate-to-severe COPD (HR = 5.46)
• Diabetes with end-organ damage (HR = 4.27)
• The need to use a mobility device (HR = 3.29)
• A history of alcoholism (HR = 1.77)

Chamie et al conclude that:

• “Men with co-morbid conditions and health states that portend poor prognoses are nonetheless aggressively treated for their prostate cancer.”
• “Advancing age modulates this effect.”

Additional discussion of this paper is provided in a report on the HealthDay web site.

Now we know that men with one or more well-rcognized co-morbid conditions who are diagnosed with prostate cancer are at significantly increased risk of death from things other than their prostate cancer. We also know that older men diagnosed with aggressive forms of prostate cancer are still at high risk for prostate cancer-specific mortality. Apparently — at least based on the data in this study — these well known facts are not being carefully considered when it comes to making good medical decisions for individuals.

Quoted in a media release from UCLA’s Jonsson Comprehensive Cancer Center related to this study, the lead author, Dr. Karim Chamie, states that:

This study suggests that men with certain medical conditions are being treated just as aggressively for their prostate cancer as men who are healthy, even though they are more likely to die of non-prostate cancer causes. Conversely, men over 75 are not being aggressively treated when they may, in fact, fare better than younger men with complicating health issues.

We know that men diagnosed with prostate cancer have individual medical problems that impact survival much more than just their age. It is high time that physicians started to treat men with prostate cancer based on their real risks from the disease and not just on preconceptions about “having cancer” or “being too old for treatment.”

How can we ever expect to be able to actually implement personalized medicine if we don’t take the simplest personal factors into account in managing the care of individual patients?

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment Tagged: | Co-morbidity, Diagnosis, Management, mortality, prognosis, risk