A recent study led by Cedars-Sinai researchers reveals that a growing number of older men in the U.S. with intermediate or high-risk prostate cancer are undergoing aggressive treatments that may not be necessary and could lead to a reduced quality of life.
These treatments, which include surgery and radiation, carry significant side effects, such as urinary incontinence and erectile dysfunction.
What’s concerning is that these men often have limited life expectancies, meaning they may not live long enough to experience the full benefits of these treatments, which can take years to improve survival rates.
Published in JAMA Internal Medicine, the study highlights a trend among older men with prostate cancer: instead of opting for a more conservative approach like “active surveillance,” some men with limited life expectancies are increasingly choosing aggressive treatments.
Active surveillance, commonly used for low-risk prostate cancer, involves regular check-ups and testing to monitor the cancer’s progression without immediate intervention.
This approach allows many patients to avoid the risks associated with surgery or radiation and is particularly beneficial for slow-growing tumors that are unlikely to threaten life.
Dr. Timothy Daskivich, the study’s lead author and director of Urologic Oncology Research at Cedars-Sinai, notes that active surveillance has become the standard approach for men with low-risk prostate cancer over the past 15 years.
However, for men with limited life expectancies, conservative management is also recommended for higher-risk cancers since they may not live long enough to see the benefits of aggressive treatments.
Surprisingly, the study found that older men in these situations are increasingly choosing surgery or radiation despite the potential drawbacks.
The study examined medical records of nearly 244,000 men diagnosed with localized prostate cancer in the Veterans Affairs (VA) health system between 2000 and 2019.
Among those with less than a 10-year life expectancy, the rate of active surveillance for low-risk prostate cancer rose, while aggressive treatments decreased from 37.4% to 14.7%.
However, for intermediate-risk cancers in the same group, treatment rates rose from 37.6% to 59.8%.
For high-risk cancers among men with less than five years of expected life, the rate of aggressive treatment almost tripled from 17.3% to 46.5%, with roughly 80% of these cases involving radiation therapy.
Dr. Daskivich and his team believe that addressing this trend requires a better understanding of life expectancy when making treatment decisions. They have proposed a “trifecta” approach to improve communication between doctors and patients.
This involves discussing the specific risks and benefits of treatment for each patient’s life expectancy, allowing patients to make informed decisions about their care.
For example, a patient might choose to pursue aggressive treatment for peace of mind, even with limited long-term benefits, while another patient may prefer a more conservative approach based on the same information.
Dr. Hyung L. Kim, chair of Cedars-Sinai’s Department of Urology, emphasized that the study underscores Cedars-Sinai’s strength in merging research with patient care.
Many Cedars-Sinai investigators are also practicing clinicians, which ensures that research is closely tied to real-life health care challenges and solutions.
Overall, this study highlights the need for a balanced approach when treating older prostate cancer patients, especially those with limited life expectancy.
It emphasizes the importance of personalized care, where patients are informed of their options, risks, and likely outcomes.
If you care about prostate cancer, please read studies about 5 types of bacteria linked to aggressive prostate cancer, and new strategy to treat advanced prostate cancer.
For more information about prostate cancer, please see recent studies about new way to lower risk of prostate cancer spread, and results showing three-drug combo boosts survival in metastatic prostate cancer.
The research findings can be found in JAMA Internal Medicine.
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