There’s more to life (and death) than prostate cancer

As reported by Reuters Health earlier today, the majority of men with early-stage, low- or moderate-grade prostate cancer do not, in fact die from this disease. This topic has been carefully addressed by a recent article in the January issue of the Journal of the American Geriatric Society. Prevention and management of other health conditions is a critical factor in the health care management of these patients.

Ketchanji et al. set out to compare the survival and causes of death in men aged 65 and older diagnosed with prostate cancer with the survival and causes of death in a non-cancer control population.

They used data from the Surveillance, Epidemiology, and End Results (SEER) database to assess the outcomes of 208,601 men between the ages of 65 and 84 years who were diagnosed with prostate cancer between 1988 and 2002. Overall, 59.1 percent of the entire group had early-stage prostate cancer with low- to moderate-grade tumors. The mortality in these patients was similar to that of men the same age without prostate cancer. Among the men with early-stage, low- or moderate-grade tumors, mortality from prostate cancer was 2.1 percent as compared to 6.4 percent from heart disease, and 3.8 percent from other forms of cancer.

The authors write that, “Once a diagnosis of cancer has been made, it can become the sole focus of medical care. This is understandable, because cancer is typically life threatening and often requires dramatic therapy. But earlier cancer diagnoses (as a consequence of screening) and improvements in treatment have been associated with lower cancer mortality. … Thus, patients are living longer after a diagnosis of cancer,” to the point where other illness may have a substantial effect on their survival.

They go on to observe that the impact of other illnesses on survival, and the high mortality rate from causes other than prostate cancer, may have important implications to the health care strategies required to optimize the long-term survival and the overall quality of life of prostate cancer patients. To give a specific example, what is the point of having a radical prostatectomy followed by radiation therapy at the age of 60 if you die of a heart attack 2 years later because you don’t appropriately manage your cardiovascular condition?

Ketchanji et al. also note that treatment decisions for localized prostate cancer should consider life expectancy based on age and the contribution of other conditions to the patient’s mortality. They point out that the decision to use androgen deprivation therapy, which is now commonly used in the treatment of even early-stage prostate cancer, must be made carefully if another significant illness is present.

The authors draw the conclusion that, “The excellent survival of older men with early-stage, low- to moderate-grade prostate cancer, along with the patterns of causes of death, implies that this population would be well served by an ongoing focus on screening and prevention of cardiovascular disease and other cancers.” The “New” Prostate Cancer InfoLink would entirely concur with this conclusion. Indeed, we would go further and note that patients wh are effecvtively treated for early stage prostate cancers should also think hard about their risks for obesity, diabetes, and other long-term debilitative disorders too.

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