Prostate Cancer Treatment Decisions Are Affected by Age

Older men with high-risk prostate cancer are frequently offered fewer, and less effective, choices of treatment than younger men, potentially resulting in earlier deaths, according to a new study.

Researchers at the University of California, San Francisco (UCSF; USA) studied 13,805 male patients enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database with complete risk, treatment, and follow-up information; high-risk patients were identified by using the validated Cancer of the Prostate Risk Assessment (CAPRA) score. Competing risks regression was used to identify the independent impact of age on cancer-specific survival; the researchers also analyzed the effect of local treatment on survival among older men with high-risk disease.

The results showed that in all, 26% of men aged 75 or older presented with high-risk disease (CAPRA score 6-10). Treatment varied markedly with age across risk strata, with older men often being undertreated through hormone therapy or watchful waiting alone, in lieu of more aggressive treatments such as surgery and radiation therapies. Controlling for age, comorbidity, and risk, the researchers found that older men with high-risk tumors receiving local therapy had a 46% reduction in mortality compared with those treated conservatively. When controlling for treatment modality alone, or for treatment and risk, age did not independently predict cancer-specific survival. The study was published in the December 6, 2010 issue of the Journal of Clinical Oncology.

"Older men with high-risk disease frequently die of prostate cancer and under-treatment might be a factor in their deaths,” said senior investigator Matthew Cooperberg, MD, MPH, a prostate cancer specialist at the UCSF department of urology. "The notion of age as a primary determinant should be reconsidered. Patients with aggressive local disease should be offered a chance of aggressive therapy that might cure them regardless of their age.”

Older men are more likely to be diagnosed with high-risk prostate cancer and to have lower overall survival. As a result, age often plays a role in treatment choice. Following the study, the researchers recommend that for older patients with localized, high-risk disease--and a life expectancy of more than 10 years -- surgical treatment and radiation be considered.

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