Elderly prostate cancer patients may be undertreated

Men over 75 years of age are being undertreated for prostate cancer, while patients with a single comorbid condition such as peripheral vascular disease are being overtreated and doing much more poorly than expected, say researchers from UCLA’s Jonsson Comprehensive Cancer Center.

"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," said first author Karim Chamie, MD. "Conversely, men over 75 are not being aggressively treated when they may, in fact, fare better than younger men with complicating health issues."

The retrospective study, which looked at the records of 1,031 men diagnosed with localized prostate cancer between 1997 and 2004, was published online in the Journal of General Internal Medicine (Sept. 21, 2011). The patients studied were being treated at the Greater Los Angeles and Long Beach Veteran’s Affairs Medical Center.

Even though prostate cancer patients with the comorbid conditions in the study had lower survival rates than those without, they were being treated just as aggressively. Approximately two-thirds of men with or without comorbidities underwent aggressive treatment for their prostate cancer.

The authors found that only 16% of men with prostate cancer who had no comorbid conditions died of other causes at the 10-year mark. Conversely, in diabetics with no associated organ damage, 35% were dead of causes other than their cancer after 10 years. In men with peripheral vascular disease treated for their cancer, 49% were dead at 10 years. In diabetics with organ damage, such as kidney or eye problems, 50% were dead at 10 years out.

"I think some physicians may think that a man with only one comorbid condition is healthier than he may in fact be," said Dr. Chamie, who worked on the study with Mark S. Litwin, MD, MPH, and colleagues. "Some patients, even those with just a single comorbid condition, might benefit from surveillance, as they may die as a result of other causes before their prostate cancer, as well as avoid being exposed to some of the debilitating side effects of treatments."

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