Study Disputes Wait-and-See Approach to Prostate Cancer

Although recent studies have produced evidence that supports aggressive treatment for younger men, none had directly addressed the question in the elderly.

Wong and her colleagues analyzed data collected for a Medicare database of about 44,630 men whose early prostate cancer was diagnosed between 1991 and 1999. The researchers followed the men until 2002, comparing the death rate of those who opted for watchful waiting with that of those who had their prostate glands removed or underwent radiation treatment within six months of their diagnosis.

Overall, those who were treated had about a 30 percent lower risk of death during the 12 years of follow-up, the researchers found after considering other factors. Even the oldest men, those 75 to 80, were 27 percent less likely to die, they found.

Wong noted that other advances in medicine have enabled men to live longer, relatively healthier lives than in the past, extending the age at which men may make good candidates for treatment.

"They teach us in medical oncology not to practice ageism," Wong said. "As people are living longer and their other medical problems are stable, I think patients should at least consider treatment."

Advances in treatment have also minimized some side effects, she said, though each patient will have to weigh the risks and potential benefits.

"We should encourage patients to talk to their physicians about the trade-offs, about the potential benefits and the potential side effects," she said.

Litwin noted that the side effects can be significant. "There is a quality-of-life cost that is often paid by undergoing treatment," he said.

Experts said doctors should evaluate patients more by their overall health and life expectancy than their chronological age.

"What I generally think about is not the age of the patient but their life expectancy," said Martin Resnick of Case Medical Center in Cleveland. "If a patient has a life expectancy of less than 10 years, it's really questionable whether they will benefit from treatment. But if a patient is otherwise healthy and has a life expectancy greater than 10 years, they may be a good a candidate."