Decisions about prostate cancer treatment should be based on disease risk and life expectancy rather than chronologic age, according to a new analysis by University of California, San Francisco, researchers. They found that older men are more likely to have high-risk disease at diagnosis and less likely to receive potentially curative local therapy.
“Under-use of potentially curative local therapy among older men with high-risk disease may in part explain higher cancer-specific mortality rates observed with increasing age,” they write in the Journal of Clinical Oncology.
Matthew R. Coopersberg, MD, MPH, and colleagues analyzed data from the Cancer of the Prostate Strategic Urologic Research Endeavor on 11,790 men with localized disease. The median age was 66 years, and 14.5% of the patients were >75 years of age.
Among men ≥75 years old, 26% had high-risk disease (Cancer of the Prostate Risk Assessment score 6 to 10). Treatment varied more with age at diagnosis than with cancer risk. Older men were more likely than younger men to be treated with androgen deprivation monotherapy and less likely to receive local therapy, regardless of risk. Age, however, was not an independent predictor of cancer-specific mortality after controlling for treatment type and risk.
Older men with high-risk tumors who received local therapy had a 46% reduction in risk-adjusted mortality compared with men who received conservative treatment.
The findings suggest that “older patients with clinically localized, high-risk disease and a noncancer life expectancy of >10 years should be considered for surgical treatment and/or radiation therapy,” the researchers conclude.