Treat Prostate Cancer in Older Men?
Study Suggests Treatment Has Survival Advantage Over 'Watchful Waiting'
Dec. 12, 2006 -- To treat or not to treat? That is the question for older
men with early-stage prostate cancer.
The jury is still out, but new research suggests a survival advantage for
older prostate cancer patients with localized disease who chose
active treatment over close observation without treatment, known as watchful
The look-back study included data from nearly 45,000 patients between the
ages of 65 and 80 with low- to intermediate-risk prostate cancer.
Over 12 years of follow-up, patients treated with either surgery or
radiation were found to have a 31% lower risk of death than patients who did
not opt for treatment.
The National Institutes of Health-funded trial is published in the Dec. 13
issue of The Journal of the American Medical Association.
"Our findings suggest that there may be a [survival] benefit associated
with treating older patients with early-stage disease," researcher Yu-Ning
Wong, MD, of Philadelphia’s Fox Chase Cancer Center, tells WebMD.
"While treatment is clearly not the right decision for every patient,
the potential for a survival advantage should enter into the decision
The latest findings appear to contradict a large Scandinavian trial,
published last year, which directly compared prostate cancer surgery to
watchful waiting. In that trial, the treatment-related survival advantage was
largely confined to men under the age of 65.
Two other large trials directly comparing treatment to nontreatment are
under way, one in the U.S. and the other in the U.K. Results from these trials
are expected before the end of the decade.
UCLA urology and public health professor Mark S. Litwin, MD, MPH, says these
trials should help clarify the issue of who needs treatment and who
He tells WebMD that the study by Wong and colleagues, while very well done,
falls short of proving that older prostate cancer patients derive a survival
advantage with treatment.
This study should not be seen as a foot on the accelerator for the treatment
of these patients, he says. "It is provocative and encouraging. But at the
end of the day it is still an observational study, and the ultimate answer has
to come from randomized, control trials."
Quality of Life
In an editorial accompanying the study, Litwin and colleague David C.
Miller, MD, MPH, wrote that quality-of-life considerations must be factored
into any decision about the treatment of early-stage prostate cancer.
Impotence, urinary incontinence, and bowel problems are all
potential side effects of the most widely used treatments for prostate
They noted that while the newly published study did show a survival
advantage for treated patients, little difference was seen in disease-specific
survival between the two groups. During the 12 years of follow-up, 8% of
treated patients and 6.8% of untreated patients died of prostate cancer.
Litwin tells WebMD that decisions about how to manage early-stage prostate
cancer must be made on a case-by-case basis, and this is especially true for
older men with the disease.
"The older a patient is, the more circumspect one ought to be before
marching ahead with a treatment that can have a significant impact on quality
of life," Litwin tells WebMD.