Treating Prostate Cancer in Elderly Men Extends Lives Compared to "Watchful Waiting"

December 13, 2006 -- Elderly men who received treatment for localized prostate cancer survived significantly longer than men who did not receive treatment, according to a study in the December 13 issue of JAMA.

Yu-Ning Wong, M.D., of the Fox Chase Cancer Center, Philadelphia, and colleagues compared outcomes from active treatment (radiation or prostatectomy) vs. observation on overall survival in a large sample of elderly men treated for low– or intermediate–risk localized prostate cancer.

The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Medicare database, a population-based cancer registry encompassing approximately 14 percent of the U.S. population.

The study gathered Medicare records data for 44,630 men age 65 to 80 years who were diagnosed between 1991-1999 with prostate cancer and who had survived more than a year past diagnosis. Patients were followed up until death or study end (December 31, 2002).

Patients were classified as having received treatment if they had Medicare claims for radical prostatectomy or radiation therapy during the first 6 months after diagnosis. They were classified as having received observation if they did not have claims for radical prostatectomy radiation or hormonal therapy. Patients who received only hormonal therapy were excluded.

A total of 111, 640 men between 65 and 80 years of age who had been diagnoised with prostate cancer diagnosis between 1991 and 1999 were included in the study. Of these men, 32,022 men were classified as receiving treatment while 12,608 were classified as untreated, "observation" group.

Results showed that patients who received treatment had a 31 percent lower risk of death during the 12-years of follow-up. In the untreated, observation group, 37 percent died while in the treatment group only 23.8 percent died.

Active treatment was associated with a significant improvement in survival in the study overall. A benefit associated with treatment was seen in all subgroups examined, including older men (age 75-80 years at diagnosis), black men, and men with low-risk disease.

"In summary, even though prostate cancer commonly is considered an indolent disease, this observational study suggests a reduced risk of mortality associated with active treatment for low- and intermediate-risk prostate cancer in the elderly Medicare population examined. Because observational data can never be free of concerns about selection bias and confounding, these results must be validated by rigorous randomized controlled trials of elderly men with localized prostate cancer before the findings can be used to inform treatment decisions," the authors write.

In an accompanying editorial, Mark S. Litwin, M.D., M.P.H., and David C. Miller, M.D., M.P.H., of the University of California, Los Angeles, comment on the findings of Wong and colleagues.

“Improvement in the quality of care for men with prostate cancer may best be achieved not by treating more patients but by treating them more discerningly. Clinicians must remain steadfast in their efforts to reduce overtreatment and undertreatment by thoughtfully defining each patient's unique balance between the natural history of prostate cancer and that individual patient's life expectancy.”

“The reported association between treatment and improved survival for older men with low- and intermediate-risk prostate cancer will be confirmed or refuted by the results of ongoing randomized controlled trials … Until then, physicians should apply these provocative findings judiciously and continue their concerted efforts to help patients make informed treatment decisions based not only on survival predictions but also on health status, functional concerns, and--most importantly--personal preference,” they write.

Full text of the JAMA article is available online, free, at:

http://jama.ama-assn.org/cgi/content/full/296/22/2683