Younger men with prostate cancer benefit from more aggressive treatment

March 19 (UPI) -- For younger men diagnosed with prostate cancer, a "wait-and-see" approach is often recommended -- sometimes delaying treatment until the disease, and its symptoms, worsen.

However, the findings of a new study published Thursday by JAMA Network Open indicate that these men may actually benefit from more aggressive therapy.

Researchers noted that those who received so-called "non-definitive therapy" -- either systemic therapy or no initial therapy -- were more than twice as likely to die from the disease than those who underwent more aggressive treatment, including surgical removal of the prostate or radiotherapy.

"Younger men with prostate cancer should not be complacent," study co-author Dr. Chad Tang, a radiation oncologist at MD Anderson Cancer Center in Houston, told UPI. "With more aggressive forms of prostate cancer, (they) should seek surgery or radiation."

Prostate cancer is the second most common form of cancer in men in the United States, after skin cancer, according to statistics from the American Society of Clinical Oncology. Roughly 200,000 American males will be diagnosed with the disease this year, 60 percent of them 65 years of age and older.

The average age at time of diagnosis is 66, per ASCO.

For their study, Tang and his colleagues looked at data for 72,036 men between 30 and 70 years old, with median age of 63, who had high-risk prostate cancer without regional lymph node or distant metastatic disease. Of these, 5,252, or 7.3 percent, initially received non-definitive therapy -- either systemic hormone-based androgen-deprivation therapy or chemotherapy or active surveillance, known as "watchful waiting."

The others underwent more aggressive treatment, such as radical prostatectomy, or surgical removal of the prostate; external beam radiation therapy; or brachytherapy-based radiation therapy, perhaps in combination with androgen-deprivation therapy.

In addition to the differences in overall survival between the two groups, the authors noted that men without health insurance, as well as those on Medicaid or Medicare, were more likely to receive systemic therapy or no treatment initially than those with private health insurance. There were also racial disparities in care, with black and Hispanic men more likely than white men to be administered systemic therapy or no treatment initially.

Between 2004 and 2014, men without insurance or who were enrolled in Medicaid had lost nearly twice as many years of life due to the disease compared with those on private insurance.

"Hopefully urologists and those at the front lines of prostate cancer treatment will take this study to suggest that aggressive pursuit of definitive therapy is warranted in younger men with more aggressive forms of prostate cancer," Tang said. "That may mean working with them to obtain insurance coverage or being more willing to accept less desirable forms of reimbursement. These men should not be treated with non-definitive treatment strategies indefinitely."

Added co-author Dr. Alex Bagley, a resident surgeon at MD Anderson, "Interventions aimed at providing greater definitive local therapy for younger patients with high-risk prostate cancer, such as expanding access to health insurance, may have a survival benefit in this population."