For most men affected by it, prostate cancer is a slow-growing disease that can be met with a go-slow approach to treatment. Some men, however, are stricken with more aggressive disease—locally advanced prostate cancer—the kind that often spreads beyond the prostate and can kill. Although doctors know how to treat locally advanced prostate cancer effectively, older men often are steered away from this treatment, with some doctors thinking that they’re not worth treating because their age trumps their survival benefit. A new study shows that this attitude is completely unjustified and that treatment standards for prostate cancer need to change.
If you are a man in his senior years who has been told that you have advanced prostate cancer or are at risk for it, here is new information that will help you make the right decision for your treatment and your life.
THERAPY TO BENEFIT ALL
Until very recently, men of all ages with locally advanced prostate cancer were generally treated with hormone therapy (androgen-deprivation therapy). Then two research studies published in 2009 and 2011 showed that radiotherapy (radiation) plus hormone therapy provided a stronger survival advantage. In fact, one study showed that, compared with hormone therapy alone, adding radiotherapy cut the 10-year prostate cancer mortality rate in half. But this and other studies were done in young and middle-aged men, not men in their 70s and beyond.
Arguing that the incidence of both prostate cancer in general and aggressive, fast-growing prostate cancer increases with advancing age, a team of researchers from the University of Pennsylvania questioned why the value of radiotherapy plus hormone therapy in older men wasn’t being examined so that better prostate cancer treatment guidelines could be created for them. The researchers analyzed treatment outcomes in 65-to-85-year-old men with high-risk prostate cancer (cancer with a likelihood of quickly worsening and spreading) and 76-to-85-year-old men with locally advanced prostate cancer. Prostate cancer–associated mortality rates of men who received the dual therapy were compared with those of men who received only hormone therapy. The study included more than 31,000 patients.
The results: In older men with high-risk prostate cancer, the addition of radiotherapy to hormone therapy reduced prostate cancer–associated mortality by three quarters and death from any cause by half. After seven years of follow-up, the mortality rate from prostate cancer was more than four times lower for men who received radiotherapy than for those who did not.
Similar results were seen in older men with locally advanced prostate cancer. Radiotherapy plus hormone therapy reduced prostate cancer–associated mortality by almost half and death from any cause by more than one-third. After seven years of follow-up, the mortality rate from prostate cancer in men who received radiation was half that of men who didn’t.
Of course, radiotherapy for prostate cancer is no walk in the park. Side effects can include impotence and bowel and bladder incontinence. Side effects of hormone therapy can include impotence, osteoporosis, anemia, muscle loss, depression and more. The researchers pointed out, however, that men receiving radiotherapy plus hormone therapy didn’t feel any more put upon by side effects than those enduring hormone therapy alone.
WEIGH YOUR OPTIONS
Deciding on a treatment plan is a personal decision—one that you should make after knowing all of the available options and how each might affect your quality of life. Men who are 75 years old now can expect to live, on average, another 12 years. Aggressive treatment for potentially aggressive disease may be worth it to you. But radiotherapy plus hormone therapy is not yet standard protocol for treatment of prostate cancer in older men because it has yet to be officially included in treatment guidelines for this population group. This study may help change that. In the meantime, there is no prohibition against it or medical insurance restrictions against coverage, but do check with your own insurance carrier about its requirements and limitations.