Otherwise Healthy Older Men Undertreated for Prostate
THURSDAY, Sept. 29 (HealthDay News) -- Men over 75 with prostate
cancer who are otherwise healthy are being undertreated for their
condition, according to a new study.
Meanwhile, younger men with prostate cancer who are affected by
other health problems -- or "co-morbid" conditions -- are being
treated for their cancer, but not responding as well as expected,
University of California, Los Angeles researchers found.
"This study suggests that men with certain medical conditions are being treated just as aggressively for their prostate cancer as men who are healthy, even though they are more likely to die of non-prostate cancer causes. Conversely, men over 75 are not being aggressively treated when they may, in fact, fare better than younger men with complicating health issues," the study's first author, Dr. Karim Chamie, a postdoctoral fellow in urologic oncology and health services research, said in a UCLA news release.
"There are individual medical problems that impact survival much more so than simply being 75 years of age," Chamie added.
In conducting the study, the researchers examined the medical
records of more than 1,000 men diagnosed with prostate cancer who
were being treated at a federally subsidized Veterans Affairs
The researchers specifically chose the VA hospital in order to
eliminate speculation that treatment decisions were also
bottom-line cost decisions. "This really speaks to the underlying
psychology of physicians and how they manage patients with prostate
cancer," Chamie explained in the news release.
Although men with prostate cancer who were also being treated
for another co-existing medical issue (such as chronic obstructive
pulmonary disease, diabetes and peripheral vascular disease) had
lower survival rates than other men, their cancer was treated just
as aggressively, the investigators found.
The study revealed that of the roughly two-thirds of men who
underwent aggressive treatment for prostate cancer, only 16 percent
who had no other health problems died of other causes after 10
In contrast, 35 percent of men who also had diabetes died of
causes not related to their cancer after 10 years. Meanwhile, the
study showed 50 percent of diabetic men who had organ damage
related to the condition died within that time frame for reasons
Similarly, 49 percent of men who also had peripheral vascular
disease who were treated for their cancer were dead within 10
years, and 65 percent of men with moderate to severe chronic
obstructive pulmonary disease also died. In both of those
situations, the men died for reasons not related to cancer,
according to the findings published in the Sept. 21 online edition
Journal of General Internal Medicine.
"I think some physicians may think that a man with only one co-morbid condition is healthier than he may in fact be," said Chamie. "Some patients, even those with just a single co-morbid condition, might benefit from surveillance, as they may die as a result of other causes before their prostate cancer and avoid being exposed to some of the debilitating side effects of treatments."
In taking the age of the men into account, however, the study
revealed that only about 25 percent of 75-year-olds were being
treated for their prostate cancer -- even though they had a 58
percent chance of surviving another decade.
"This study suggests that while physicians use patient age of 75 as a very strong cue to avoid overtreatment of men with prostate cancer, they are less likely to integrate certain co-morbidities into prostate cancer decision making," concluded Dr. Mark S. Litwin, chairman of the urology department and a researcher at UCLA's Jonsson Comprehensive Cancer Center, in the release. "There are some medical conditions that portend a poor prognosis and should therefore be taken into consideration in the decision-making process."
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