According to the results of a study published in The American Journal of Medicine, aggressive treatment of prostate cancer in men aged 75 or older was linked with worse quality of life and only a small survival benefit.

The prostate is a gland of the male reproductive system. It produces some of the fluid that transports sperm during ejaculation. After skin cancer, prostate cancer is the most common form of cancer diagnosed in men. The outlook for men diagnosed with prostate cancer is good: overall survival rates for all stages of prostate cancer have improved dramatically over the past 20 years.

Current treatment options for prostate cancer include surgery, chemotherapy, radiation, hormonal therapy, or watchful waiting. Watchful waiting is an approach in which no treatment is administered until a specified point of disease progression. Although previous studies have indicated that active treatment provides superior long-term outcomes to watchful waiting in early prostate cancer, research continues to compare strategies as treatment is associated with side effects such as erectile dysfunction and urinary incontinence.

A factor that may influence treatment choice is the health of the patient. Patients who have a short life expectancy due to other chronic health problems may be less likely to benefit from active treatment than patients with a longer life expectancy. Although health status isn’t necessary linked with age, researchers continue to explore how treatment outcomes vary by age.

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To assess prostate cancer treatment outcomes among elderly men, researchers evaluated 465 prostate cancer patients between the ages of 75 and 84. One hundred and seventy-five of the men had been treated with prostatectomy or radiation therapy (the aggressive therapy group) and 290 had received no treatment or hormonal therapy only (the conservative management group).

  • By two years after prostate cancer diagnosis, over 80% of the deaths among study participants were from causes other than prostate cancer.
  • Men who received aggressive treatment were less likely to die of prostate cancer; the difference in risk between treatment groups, however, was only 6%.
  • Men who received aggressive treatment were more likely to report daily urinary leakage and to be bothered by urinary and sexual problems.

The researchers conclude that aggressive treatment of prostate cancer slightly improved survival among prostate cancer patients aged 75 or older, but decreased quality of life. The researchers note that “Physicians and older patients should consider these outcomes in making decisions about screening and treatment.”

Reference: Hoffman RM, Barry MJ, Stanford JL et al. Health Outcomes in Older Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes study. The American Journal of Medicine. 2006;119:418-425.