2 weeks Ago By City News Service
Increasing numbers of older US men with prostate cancer are undergoing treatments that carry risks of side effects that can significantly reduce the quality of life without extending life, according to a Cedars-Sinai study published Monday. Researchers said these men might not have life expectancies that would allow them to receive the benefits of more aggressive treatments. The findings were published in the peer-reviewed journal JAMA Internal Medicine, and can be read at jamanetwork.
com/journals/jamainternalmedicine/article-abstract/2825764 . Prostate cancer is the second-most common cancer in the United States, exceeded only by breast cancer. About one-eighth of U.
S. men are diagnosed with prostate cancer at a median age of 67, according to the National Cancer Institute. Most patients have slow-growing, localized tumors, confined to the prostate gland, that are unlikely to threaten their lives.
Instead of immediate treatment, these low-risk patients can be monitored through “active surveillance,” in which examinations and tests are performed on a regular schedule to make sure the disease is not progressing. “Conservative management,” which includes active surveillance or watchful waiting, is also recommended for men with limited life expectancies who likely will not live long enough to benefit from aggressive local treatment, even for higher-risk cancers. However, for these men, the trend is going in the opposite direction, as measured by the investigators’ analysis of extensive data from the U.
S. Veterans Affairs health system. They found that for men with limited life expectancies and intermediate- and high-risk cancers, conservative management was being employed less often and more were receiving aggressive local treatment with surgery or radiation.
“We found this pattern surprising,” said Dr. Timothy Daskivich, director of Urologic Oncology Research for the Cedars-Sinai Department of Urology and corresponding author of the study. “Prostate cancer patients with life expectancies of less than five or 10 years were being subjected to treatments that can take up to a decade to significantly improve their chances of surviving cancer, despite guidelines recommending against treatment.
” The study analyzed medical data on 243,928 men in the Veterans Affairs health system who were diagnosed with localized prostate cancer between 2000 and 2019. Among patients with average life expectancies of less than 10 years, the proportion who underwent treatments such as surgery or radiation for low-risk prostate cancer rather than receiving active surveillance decreased from 37.4% to 14.
7%; but treatment for intermediate-risk disease increased from 37.6% to 59.8%.
Among patients with average life expectancies of less than five years, treatment for high-risk disease increased from 17.3% to 46.5%.
Among men who were overtreated, roughly 80% were treated with radiation therapy. Daskivich said that solving the issue of overtreatment in higher-risk patients with limited longevity requires a multifaceted approach involving better estimation, communication and integration of life expectancy into decision-making. He and his team proposed a “trifecta” method for communicating cancer prognosis to the patient, with doctors discussing the likelihood of dying from the cancer with treatment vs.
without treatment at the endpoint of the patient’s life expectancy. “Our goal is to encourage clinicians to make longevity part of the discussion about the best treatment options so that prostate cancer patients with limited life expectancies can make educated choices,” Daskivich said..
