OVERTREATMENT of prostate cancer persists among men with limited life expectancy within the Veterans Affairs (VA) health system. Despite the adoption of active surveillance, particularly for low-risk prostate cancer, the study reveals increasing overtreatment with radiotherapy among men with intermediate- and high-risk prostate cancers who are unlikely to benefit from such interventions due to their limited longevity.
The study evaluated 243,928 veterans diagnosed with clinically localized prostate cancer from 2000 to 2019, categorizing life expectancy through the Prostate Cancer Comorbidity Index (PCCI). Among men with less than 10 years’ life expectancy, rates of surgery and radiotherapy for low-risk prostate cancer dropped from 37.4% in 2000 to 14.7% in 2019, a promising trend. However, treatment rates for intermediate-risk prostate cancer rose significantly, increasing from 37.6% to nearly 60%. Notably, radiotherapy was the primary treatment used, particularly for patients with intermediate and high-risk cancers who had less than 10 years’ expected longevity.
For those with even shorter life expectancy (less than five years), high-risk prostate cancer treatment rates increased from 17.3% to 46.5%, with radiotherapy as the predominant approach (85%). The trend suggests that despite improved management of low-risk cases through surveillance, intermediate- and high-risk prostate cancer in men with limited life expectancy continues to be overtreated. This raises concerns about unnecessary treatment toxicity and patient quality of life in cases unlikely to derive survival benefit.
Reference: Daskivich TJ et al. Overtreatment of prostate cancer among men with limited longevity in the active surveillance era. JAMA Intern Med. 2024.
