Treat prostate cancer regardless of patient age
According to a new study, the decision on the type of therapy should focus rather on the risk of progression of the tumor, further findings and the life expectancy of the person concerned.The incidence of prostate cancer in older men in the decades to continue to rise, because life expectancy increases and the tumor often occurs with age. However, patients are excluded over 75 years of most studies, and in the U.S. there is a recommendation, not to carry out prostate cancer screening in men of this age, based on extrapolations from younger men. Have also been reported both unnecessary and of inadequate treatment in elderly patients.
In the elderly, a tumor in the United States often high-risk detected than in younger ones, and they have a lower overall and prostate cancer-related survival. Whether the latter actually depends on the age or other factors, has not yet been adequately studied. Nevertheless, the age often has great influence on the choice of treatment.
In their new study, the researchers wanted to determine whether, with the same risk and the same tumor therapy the patient's age affect its survival, and whether an age-dependent choice of treatment is the reason for the observed differences in survival rates. To this end, they analyzed a database (CaPSURE), in the since 2008 almost 14,000 Americans were captured with proven prostate cancer. Of these, almost 12,000 were able to be included with localized cancer in the present study. They were divided based on the information in an age and risk groups and put them in relation to the treatment carried out and general and prostate cancer-related survival.
The results: In the sectional 66 years old men increased with age, not only the number of concomitant diseases, but also the probability of higher PSA values and Gleason score in the diagnosis as well as for a larger tumor (clinical T stage) while the proportion of affected tissue in the biopsy remained virtually the same. This means a strong tendency for tumors with higher risk (high risk of 6% to 33% increase, medium risk from 26% to 42% rising and low risk from 68% to 25% falling, each of the group of bis-54- olds up to the Ab-80-year-olds).
The treatment varied more with age than with a higher risk of tumors. Older received a total much less local therapy than younger people, regardless of their risk group ( radical prostatectomy decreasing from 85% to 3%, radiotherapy increasingly from 9% to 35%). In contrast, more often was an immediate hormone therapy (from 3% to 41% increase) or monitoring (from 2% to 19% increase).
With age, the overall survival probability, as expected, decreased significantly. This was to a lesser extent for the prostate cancer-specific survival. However, the effect was not detectable when compared with the same sub-groups the treatment and / or the same tumor risk. From the From-70-year-old with a tumor with a high risk almost every second died in less than 6 years, but it only every fifth prostate cancer. After local therapy, the mortality rate in this group was only about half as high as that of a non-local treatment.
Although their study also had weaknesses (eg in data collection), the authors supported the results of other investigations. Thus the higher mortality of older people explain with a high-risk tumor in part to the fact that she rarely a potentially curative local treatment received from their younger counterparts. In addition, the incidence of cancer and thus the mortality was not a question of age, but the degeneration of tissue whose viciousness let be divided into risk groups. In the elderly, with a life expectancy of more than 10 years and a localized tumor with high-risk, therefore, a surgery or radiotherapy should be considered.
According to the authors in treating the elderly is currently not optimal. This should be more at risk of tumors and the findings are based on age as or against current practice. Thus, the mortality of the elderly with a high risk of tumors with a local therapy could be almost halved.The recommendation in the U.S. against prostate cancer screening in men over 75 years is too general and to the detriment especially of older people with otherwise good health.
The life expectancy could be still difficult to estimate. To determine the appropriate therapy still tumor risk and comorbidities should be identified in order to avoid both unnecessary treatment with low risk and inadequate treatment at high risk. The former could be the result of an overestimation of life expectancy, especially in the elderly. However, the second consists is a least as big problem according to the results of this study.
Conclusion of the authors
Compared to younger, older men with prostate cancer often a tumor with a high risk of progression of the disease and more likely to receive an immediate hormone therapy as local treatment. In addition, their overall survival probability is lower. With the same treatment and the same risk of tumors, the prostate cancer-related survival is no different. In the elderly, with a localized tumor with a high risk of mortality is only about half as high when local treatment is done. Thus, it is important to decide on the risk and life expectancy and less on the age of the treatment. Most older patients with prostate cancer with low risk are candidates for active surveillance, but some with a more aggressive tumor should not be denied a possibly curative local therapy.
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