Disease risk, not age, should influence PCa treatment decisions, authors advise

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, results of a recent study indicate.

Researchers from the University of California, San Francisco found that men older than 75 years of age 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 therapies. Instead, say the researchers, old age should not be viewed as a barrier to treatments that could lead to potential cures.

"There is a disconnect between risk and treatment decisions among older men," said senior investigator Matthew R. Cooperberg, MD, MPH. "Patient age is strongly influencing treatment decisions, so we sought to understand whether age plays a role in risk of the disease and survival. We found that undertreatment of older men with high-risk disease might in part explain higher rates of cancer mortality in this group. There is also pervasive overtreatment of low-risk disease in this age group. Overall, treatment needs to be selected more based on disease risk and less based on chronologic age."

The team studied men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database. At the time of the study, the database contained information on 13,805 patients. The researchers found that older patients are more likely to have high-risk prostate cancer at the point of diagnosis and less likely to receive potentially curative local therapy. Yet when older, high-risk men received more aggressive treatment, they had a 46% lower death rate than patients treated more conservatively with hormonal therapy or watchful waiting.

Results from the study were published in the Journal of Clinical Oncology (2011; 29:235-41).