Conservative Management of Prostate Cancer: Favourable 15-Year Outcomes in Older Patients with Low-Risk Disease

SURVIVAL outcomes among patients with low-risk prostate cancer (PrC) are favourable when initially treated with conservative management, according to data from a population-based study by investigators at Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.

Previous research by the study’s lead author Dr Grace Lu-Yao, cancer epidemiologist, Rutgers Cancer Institute of New Jersey and Professor of Medicine, Rutgers Robert Wood Johnson Medical School, and colleagues analysed 10-year outcomes for this population. The 2009 research illustrated that men diagnosed with PrC originating in the early 1990s had significantly improved survival compared with patients whose cancers were diagnosed in previous decades. Due to the protracted nature of the condition and increasing longevity in elderly men, 10-year follow-up may not suffice when selecting informed treatment strategies. Dr Lu-Yao observed that this new study, which lengthened data analysis by an extra 5 years, “helps provide a more complete picture of potential outcomes for patients who have a life expectancy greater than 10 years.”

The new study analysed 33,137 Medicare patients aged 65 or older who were diagnosed with early-stage PrC (T1 or T2) from 1992 through 2009 and received conservative management (no surgery, radiotherapy, cryotherapy, or androgen deprivation therapy) within the first 6 months of diagnosis. Researchers discovered that men aged 65-74 with a Gleason score of 5‒7 had a reduced risk of PrC-induced death over a 15-year period compared to men aged 75 and older (5.7% versus 10.1%). For men with the highest level Gleason scores (8‒10), 15-year PrC mortality rates were 22% for men aged 65-74 and 27% for men aged 75 and older. The mortality rates remained relatively stable from 6-16 years following diagnosis.

Dr Lu-Yao added that the study may help to alter the conversation between physician and patients. “In weighing whether treatment benefits outweigh the risks, radical prostatectomy – for instance – is typically not recommended for older men with low-grade disease. But many elderly patients are treated with radiotherapy or hormonal therapy even if their cancer is indolent, so that they can feel like they are doing something,” she said. “By having additional data available to support conservative management, doctors can further educate their patients about survival outcomes and possibly help avoid treatments that may put the patient at risk.”

Alex Watt

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