Prostate cancer treatment beats waiting

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WASHINGTON, Feb. 24 (UPI) -- Running counter to common advice that older men with prostate cancer "watch and wait," new research has found that treating the cancer, regardless of age, prolongs the life of patients.

In a study of men who received treatment, in the form of surgery or radiation therapy, researchers found they lived longer than people who either did not get treated or deferred their treatment.

"It's an optimistic study. It's nice to know what we've been doing for people is probably helping them," said lead author Yu-Ning Wong, a medical oncologist at Fox Chase Cancer Center in Philadelphia.

Wong will present her findings Saturday at the 2006 Prostate Cancer Symposium in San Francisco.

Wong and colleagues examined the survival data of more than 48,606 men between the ages of 65 and 80, who had recently been diagnosed with prostate cancer. The men had no cancer in other parts of their body. The data came from a large population of Medicare patients across the United States, who were diagnosed between 1991 and 1999. She found most of the men who got treatment had a distinct survival advantage over untreated patients.

In the untreated patients, median survival was 10 years after diagnosis, and median survival for those treated was 13 years. Even when Wong made adjustments to the study to cover differences such as age, race, and marital status, treatment still trumped watchful waiting. Wong also noted that the study did not compare the benefit of either surgery or radiation as treatments, just that both increased the lives of men with prostate cancer.

The study comes amidst an "incredible controversy" over how to tackle prostate cancer, Wong said. The only previous research to look at survival and treatment was a randomized study published in the New England Journal of Medicine in 2005, which studied 700 Scandinavian men over more than eight years. The men were grouped into those who underwent a radical prostatectomy, or removal of the prostate, and those who did not receive treatment. The group who had surgery enjoyed a 44 percent higher survival advantage than the untreated group.

Prostate cancer, the most common cancer in men and their second leading cause of death, usually afflicts men 65 and older. More than half of all men older than 80 have some form of cancer in their prostate, according to the National Cancer Institute.

It's also what Wong calls an "indolent," or slow-developing, cancer. This makes treatment decisions for prostate cancer more complicated for doctors, since it's possible patients will die of other diseases first. Currently, the majority of men seek treatment for their cancer, although watchful waiting is still a popular idea, Wong said.

Wong's study suggests the waiting game may actually be detrimental to men, said Gary Hudes, the director of Genitourinary Malignancies at Fox Chase and a co-author of the study. "This redefines what the goal of treatment is," he said.

For example, Hudes said with the current life expectancy, men who are 70 years old could have an additional 14 years of life -- and so doctors can't think short term. Unless a patient has a short life expectancy, it may be better to choose treatment, he said.

"This adds another piece of evidence in favor of treating men, even if they're in their 70s," Hudes said. "It's not saying 'Well, it's prostate cancer and there's no need to do treatment.' These data suggest otherwise."

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