Elderly patients may be undertreated for prostate cancer
It's an ongoing debate: Should men over a certain age be treated for prostate cancer? Should these patients be submitted to treatments that may result in significant side effects if they may not live very much longer?
Now, a study by researchers at UCLA's Jonsson Comprehensive Cancer Center has shown that men over 75 with prostate cancer are being undertreated, while patients with a single comorbid condition such as peripheral vascular disease or those in wheelchairs are being over-treated and doing much more poorly than expected.
"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," said Dr. Karim Chamie, a postdoctoral fellow in urologic oncology and health services research and first author of the study. "There are individual medical problems that impact survival much more so than simply being 75 years of age."
The retrospective study, which looked at the records for 1,031 men diagnosed with localized prostate cancer between 1997 and 2004, appears today in the early online edition of the Journal of General Internal Medicine.
The patients studied were being treated at the Greater Los Angeles and Long Beach Veteran's Affairs Medical Center, where care is subsidized through a federal program. So there was no financial incentive to treat patients in the study, removing physician reimbursement from the equation.
"Because these are VA patients, it eliminates any speculation or concern that treatment decisions were being made with reimbursement or the bottom line in mind," Chamie said. "This really speaks to the underlying psychology of physicians and how they manage patients with prostate cancer."
In this study, Chamie and his team sought to determine the probability of prostate cancer treatment and survival among men with a single comorbid condition. They measured the risk of undergoing treatment for men with a host of medical problems, such as chronic obstructive pulmonary disease (COPD), diabetes with and without organ damage, congestive heart failure, stroke, heart attack, liver disease, peripheral vascular disease and other comorbid conditions.
Even though prostate cancer patients with the comorbid conditions had lower survival rates than those without, they were being treated just as aggressively. Approximately two-thirds of men with or without comorbidities underwent aggressive treatment for their prostate cancer.
The study found that only 16% of men with prostate cancer who had no comorbid conditions died of other causes at the 10-year mark. Conversely, in diabetics with no associated organ damage, 35% were dead after 10 years of causes other than their cancer. In men with peripheral vascular disease treated for their cancer, 49% were dead at 10 years. In diabetics with organ damage, such as kidney or eye problems, 50% were dead at 10 years out. And in men with moderate to severe COPD, 65% were dead at the 10-year mark.
The study also examined the age of patients and found that only about a quarter of men aged 75 were being treated for their prostate cancer, even though their chances of living another 10 years were 58%.
"I think some physicians may think that a man with only one comorbid condition is healthier than he may in fact be," Chamie said. "Some patients, even those with just a single comorbid 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."
"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 comorbidities into prostate cancer decision making, "said Dr. Mark S. Litwin, professor and chairman of the urology department and a researcher at UCLA's Jonsson Comprehensive Cancer Center. "There are some medical conditions that portend a poor prognosis and should therefore be taken into consideration in the decision-making process."
Provided by University of California - Los Angeles
- Family history of prostate cancer does not affect some treatment outcomes Jan 02, 2009 | not rated yet | 0
- Radiation seeds effectively cure prostate cancer in young men Oct 29, 2007 | not rated yet | 0
- Men with wives, significant others more likely to be screened for prostate cancer Dec 08, 2008 | not rated yet | 0
- Androgen deprivation therapy for localized prostate cancer not associated with improved survival Jul 08, 2008 | not rated yet | 0
- Younger men with advanced prostate cancer have shorter survival times May 22, 2009 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
May 23, 2013 Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
In recent years, microRNAs (miRNAs) and other non-coding RNAs are small molecules that help control the expression of specific proteins. In recent years they have emerged as disease biomarkers. miRNA profiles have been used ...
Cancer 7 hours ago | not rated yet | 0
Cancer cells spread and grow by avoiding detection and destruction by the immune system. Stimulation of the immune system can help to eliminate cancer cells; however, there are many factors that cause the immune system to ...
Cancer 7 hours ago | not rated yet | 0
Researchers from London's Kingston University have begun a two-year study which could help prolong the lives of people with colorectal tumours.
Cancer 11 hours ago | 5 / 5 (1) | 0
Transformative research from Western University has identified new hormones in the body which may suppress breast cancer and stimulate the regression of breast tumors.
Cancer 11 hours ago | 5 / 5 (1) | 0
(Medical Xpress)—Curtin University researchers have found evidence that targeting specific cells in the body can reverse the effects of cancer on the immune system.
Cancer 12 hours ago | 5 / 5 (3) | 0
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
5 hours ago | 5 / 5 (1) | 0 |
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
11 hours ago | 5 / 5 (3) | 0 |
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
8 hours ago | 5 / 5 (1) | 0 |
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
8 hours ago | 5 / 5 (2) | 0 |
Talking on a hands-free device while behind the wheel can lead to a sharp increase in errors that could imperil other drivers on the road, according to new research from the University of Alberta.
5 hours ago | not rated yet | 0
Kate O'Reilly's spring allergy survival kit includes the usual stuff - nasal sprays, allergy pills and a box of tissues. This season, she's added a new weapon to her line of defense: an app on her smartphone.
6 hours ago | not rated yet | 0