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How should prostate cancer be treated in older men?

Dr. Audrey K. Chun, MD
Geriatric Medicine Specialist

Older men with high-risk prostate cancer frequently are offered fewer—and less effective—choices of treatment than younger men, potentially resulting in earlier deaths, according to a study in the January issue of the Journal of Clinical Oncology. The study found that men older than 75 with high-risk prostate cancer often are undertreated through hormone therapy or watchful waiting alone in lieu of more aggressive treatments such as surgery and radiation.

Instead, say the researchers, old age should not be viewed as a barrier to treatments that could lead to potential cures, citing their findings that when older, high-risk men received more aggressive treatment, they had a 46 percent lower death rate compared with patients treated more conservatively with hormonal therapy or watchful waiting. The study also found pervasive overtreatment of low-risk disease in this age group, and the researchers concluded that overall, treatment needs to be selected more based on disease risk and less based on chronologic age, particularly in older men with a life expectancy of more than 10 years.

Any doctor will treat a person for cancer if he or she thinks that treatment will extend that person's life and reduce suffering, regardless of that person's age. And many men over age 60 are treated for prostate cancer.

Most people think of all cancers as really bad actors that grow rapidly, damage the organ that they started in, and spread (metastasize) throughout the body. But some cancers—and prostate cancer is a good example—often don't grow rapidly and spread. In fact, a lot of men die of other causes and are found on autopsy to have small undiagnosed cancers inside their prostate glands that never caused any symptoms. These "indolent" cancers have probably been there for years. The men died with but not from prostate cancer.

At the same time, treatments for prostate cancer—surgery, radiation, chemotherapy—can cause harmful side effects like an inability to control urination (urinary incontinence) and erectile dysfunction. No one wants the treatment to be worse than the disease, and that's much more likely to happen if the potential of harm from a disease is low.

Doctors have ways of estimating whether a newly discovered prostate cancer is more likely to be aggressive or indolent, although the predictions are not as precise as we would like. When a prostate cancer appears to be indolent, doctors sometimes suggest to patients that it be closely monitored for growth or spread, instead of treating it right away. That approach is called watchful waiting, although to make it sound more appealing, some doctors have renamed it active surveillance. Regardless of what you call it, it's often the best course of action.

Harvard Medical School 2011 Annual Report on Prostate Diseases

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Harvard Medical School 2011 Annual Report on Prostate Diseases

Prostate disorders usually develop after age 50, but some men experience them at a younger age. The three most common conditions are prostatitis, benign prostatic hyperplasia (BPH), and prostate...

Most men could be diagnosed with prostate cancer at 80 years of age if biopsies were done. But, at this age, treating prostate cancer usually does not increase life expectancy. That is to say that something else is far more likely to be a cause of death. Because treatment can cause significant morbidity, it is not generally recommended in this older age group. This has prompted most major physician and medical organizations to recommend against screening men older than about age 70.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.