• Posted November 13, 2024

Overtreatment Common for Older Men With Prostate Cancer

Overtreatment of prostate cancer is increasing in the United States among men with limited life expectancy, a new study reports.

Procedures like radiation therapy and prostate surgery are being employed more often in these men, causing side effects like incontinence and impotence without adding any more years to their lives, researchers found.

Two-thirds of men with intermediate-risk prostate cancer and nearly half of men with high-risk cancer are receiving treatment that frequently proves harmful and useless, they added.

“We found this pattern surprising,” said lead researcher Dr. Timothy Daskivich, director of urologic oncology research for Cedars-Sinai Medical Center in Los Angeles.

“Prostate cancer patients with life expectancies of less than five or 10 years were being subjected to treatments that can take up to a decade to significantly improve their chances of surviving cancer, despite guidelines recommending against treatment,” Daskivich added in a Cedars-Sinai news release.

This trend runs counter to efforts promoting “active surveillance” of prostate cancers in men where treatment would needlessly harm their quality of life.

This “watch-and-wait” approach is recommended for all prostate cancer patients who will likely die of some other cause, whether it’s men with low-risk, slow-growing cancer or those with more advanced cancer but only a few years of life left, researchers said.

 “Use of active surveillance has increased over the last 15 years for men with low-risk prostate cancer, and it is now the most common treatment for these men,” Daskivich said. “This approach allows these patients to avoid the risks of urinary incontinence, erectile dysfunction and other potential side effects of surgery and radiation therapy.”

For this study, researchers analyzed medical data on nearly 244,000 men diagnosed in VA hospitals with prostate cancer between 2000 and 2019.

Results show that radiation therapy or surgery for men with low-risk prostate cancers decreased from 37% to 15% during that period, as recommended.

However, treatment for intermediate-risk prostate cancer increased from 38% to 60%, researchers found. 

And in men with average life expectancies of less than five years, treatment for high-risk prostate cancer increased from 17% to 47%.

Radiation therapy is most often used in unnecessary prostate cancer treatment, employed 80% of the time, researchers found.

The use of radiation therapy increased from 16% to 39% among men with a life expectancy of less than five years, the study showed.

The new study was published Nov. 11 in the journal JAMA Internal Medicine.

To prevent overtreatment, Daskivich and his team have proposed a “trifecta” method for discussing a prostate cancer prognosis with patients.

In this method, the doctor would discuss the likelihood of dying from the cancer with treatment versus without treatment, given the patient’s individual life expectancy.

“Our goal is to encourage clinicians to make longevity part of the discussion about the best treatment options so that prostate cancer patients with limited life expectancies can make educated choices,” Daskivich said.

“A patient may be given this data and choose to pursue surgery or radiation treatments regardless of a limited probability of benefit. Another patient may take a different course,” Daskivich added.

“Every individual is different, and statistical averages for lifespan, treatment effectiveness and cancer risk cannot predict outcomes with certainty,” Daskivich concluded. “But patients should be given the opportunity to make informed decisions with the best possible information.”

More information

The American Cancer Society has more on prostate cancer.

SOURCE: Cedars-Sinai Medical Center, news release, Nov. 11, 2024