According to researchers at UCLA’s Jonsson Comprehensive Cancer Center the debate is ongoing: 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? A study published online on September 26 in the early online edition of the Journal of General Internal Medicine reported 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; furthermore, these patients are 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 reviewed the records of 1,031 men diagnosed with localized prostate cancer between 1997 and 2004 who were being treated at the Greater Los Angeles and Long Beach Veteran’s Affairs Medical Center. In these facilities, healthcare is subsidized through a federal program; therefore, there was no financial incentive to treat patients in the study, removing physician reimbursement from the equation.
The researchers 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. “I think some physicians may think that a man with only one comorbid condition is healthier than he may in fact be,” Dr. 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.”
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