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According to the results of a study published in the Journal of the American Medical Association, treatment of localized prostate cancer with radiation therapy or radical prostatectomy results in better survival than observation in men between the ages of 65 and 80 years.

Patients diagnosed with localized prostate cancer (cancer confined to the prostate) often must choose among “watchful waiting”, more aggressive treatment with radiation or surgery (radical prostatectomy), or participation in a clinical trial.

Watchful waiting refers to 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 these 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 explore whether active treatment of localized prostate cancer results in better survival than watchful waiting in elderly men, researchers evaluated information from a large U.S. cancer registry. The study involved more than 44,000 men between the ages of 65 and 80. All men had low- or intermediate-risk prostate cancer that was confined to the prostate.

  • 32,022 of the men received treatment with radical prostatectomy or radiation therapy, and 12,608 had watchful waiting.
  • By the end of 12 years, 37% of men in the watchful waiting group had died compared to 24% of men who received active treatment.
  • After accounting for several differences between the two groups of men, those who had received active treatment had a 31% lower risk of death than those in the watchful waiting group.
  • Active treatment produced a survival benefit even among the oldest men in the study (those between the ages of 75 and 80).

The researchers conclude that active treatment of low- or intermediate-risk, localized prostate cancer improves survival in elderly men. The researchers note that these results should be confirmed in a randomized clinical trial.

Reference: Wong Y-N, Mitra N, Hudes G et al. Survival Associated with Treatment vs Observation of Localized Prostate Cancer in Elderly Men. Journal of the American Medical Association. 2006;296:2683-2693.