According to Reuters, a new article, forthcoming on line in the Annals of Internal Medicine, tells us (not too surprisingly) that, “Older men with other illnesses may not live long enough to benefit from aggressive prostate cancer treatments, such as prostate removal or radiation, and they’d have to live with their side effects.”
Apparently, in an editorial that accompanies the main article, Lazzaro et al. write that, “The challenge for the physician is to accurately evaluate the life expectancy of a patient in order to balance the risk for prostate cancer mortality with that of other-cause mortality.”
Again, this is hardly a surprise to anyone with even a limited understanding of the natural history of prostate cancer in older patients … and prostate cancer is most common in men > 60 years of age.
The article in Reuters was supposedly to be published on line earlier this week, and we had been hoping to be able to see at least the abstract of the paper in the Annals of Internal Medicine, but as of this morning that abstract is still not available on line. That article is based on additional data from the Prostate Cancer Outcomes Study (PCOS) that we also referred to yesterday.
“If you’re going to die of a heart attack in 5 years, what’s the point of going through radiation?” Dr. David Penson, the study’s senior author is quoted as asking by Reuters. “The key point is that when men are choosing therapy for prostate cancer, they need to consider their tumor characteristics, their age and other characteristics,” he continues.
According to Reuters, in the study data reported in the Annals of Internal Medicine, and based on the PCOS data set (which included men between 39 and 89 years of age diagnosed between October 1994 and October 1995), Penson et al. report that, after tracking these men for some 15 years from diagnosis:
- The risk of dying from high-risk prostate cancer was 18 percent.
- The risk of dying from low-risk prostate cancer was 3 percent.
- Older men were more likely to die from something other than prostate cancer during the 10 years following diagnosis if they had other ailments.
- For men with three or more co-morbid conditions
- About 40 percent of men of 61 to 74 years of age died of something else within 10 years of their prostate cancer diagnosis.
- About 71 percent of men of 75 years and older died of something else within 10 years of their prostate cancer diagnosis.
We are not yet able to use the data from this study to individualize decision making about the management of prostate cancer or the appropriateness of active surveillance over invasive therapies. However, what this study does tell us very clearly is that, even among men being diagnosed nearly 20 years ago, the risk of death from prostate cancer within 10 years of diagnosis among men diagnosed with low-risk disease is small, and it is particularly small for men with one or more co-morbidities. Thus the potential benefits of treatment for men with a life expectancy of 10 years or less are limited by comparison with the risks to quality of life from the treatment itself. By comparison, active surveillance and other forms of careful monitoring look like excellent potential options.