Older, sicker men should consider avoiding treatment for prostate cancer: UCLA study

Prostate Cancer

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Dr. Katsuto Shinohara (L) and Dr. I-Chow Hsu review images of a cancerous prostate before performing bracytherapy on a man with prostate cancer at the UCSF Comprehensive Cancer Center.

A UCLA-led study published Monday may help doctors identify which prostate cancer patients should not undergo treatments that cause debilitating side effects. It confirms that men in their 60's and older afflicted with other serious illnesses are more likely to die from one of those illnesses than from the prostate cancer. 

The National Urological Association already recommends that men who are not expected to live more than ten years beyond diagnosis of slow growing prostate cancer consider going without surgery, external radiation, or radioactive seed implants. That's because those treatments carry with them the risk of erectile dysfunction, urinary incontinence and bowel problems. 

But identifying which patients fall into that category isn't easy for doctors.

"It's been  difficult to predict who is and who isn’t going to live for ten years," says Dr. Timothy Daskivich,  a UCLA Robert Wood Johnson fellow  who led the multi-university research. "We found  doctors actually do a poor job of predicting this. As a result many older and sicker men currently are getting overtreated for  low-to intermediate-risk prostate cancer."

Daskivich and his colleagues, including researchers from the Department of Preventative Medicine at USC's Keck School of Medicine, explored the long-term survival rates of 3,183 men with prostate cancer.

The researchers found that men in their 60s and older with slower-growing forms of the cancer and with three or more other serious illnesses -- such as heart disease, diabetes, and hypertension -- are far more likely to die from one of those illnesses than from their prostate cancer.

For those men, an "active surveillance" approach to the cancer may prove to be a better choice than aggressive treatment, Daskivich says. 

By contrast, he says older patients with high-risk, aggressive forms of prostate cancers may do best to choose surgery or radiation. 

Daskivich says he hopes the study, published in the online edition of the Annals of Internal Medicine, will help doctors and their patients make better choices when assessing the risks and benefits of prostate cancer treatments.

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