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New study shows many men over 65 benefit from surgery and radiation treatment
Toronto (Sept. 2, 2003) - Age should not be a barrier to treatment for older men who are relatively healthy but have aggressive prostate cancer, say researchers with University Health Network.
In a study published this week in the Journal of Clinical Oncology, researchers examined if men above the age of 65 benefit from radical prostatectomy (where the prostate is surgically removed) or external beam radiation, both of which can potentially cure prostate cancer. Previous studies have shown that in practice many older men with aggressive prostate cancer do not receive potentially life-prolonging treatment.
"This study shows that healthy older men, particular those in their 70s, who have aggressive prostate cancer benefit significantly from surgery or radiation therapy," said Dr. Shabbir Alibhai, lead author of the study, a physician with University Health Network, and lecturer with the University of Toronto's Departments of Medicine & Health Policy, Management, and Evaluation. "These patients can receive an extra year of life or more, with most having an improved quality of life as well."
The study compiled data from a variety of sources, including previous studies of outcomes from surgery, radiation treatment and "watchful waiting" (where the tumour is monitored for growth but no treatment is taken). Researchers developed a mathematical model to weight a variety of factors including life expectancy of patients and quality of life issues.
The results showed that for men with prostate cancer that was slow growing, or even moderately aggressive prostate cancer, the benefits of curative treatments were not as dramatic. Often, it came down to a patient's value of preserving sexual function (impotence is sometimes a side effect of treatment), or the patient's willingness to leave his disease untreated. The most dramatic results were with men up to the age of 80 who had aggressive prostate cancer but were otherwise healthy.
"Our findings indicate that current age thresholds for treatment are set too low for healthy men fighting aggressive prostate cancer," said Dr. Alibhai. "What is most clear from our results is that potentially curative therapy should be seriously considered in reasonably healthy men up to the age of 80 years who have an aggressive, high-grade cancer."
"This is an important study showing that ageism should not be part of our medical decision making," said Dr. John Trachtenberg, head Princess Margaret Hospital's Prostate Centre. "A healthy man in his 70s or early 80s can still be fitter, and benefit more from treatment, than a younger man who has not taken care of himself. These patients should not be denied appropriate care just because of their age."
The research was supported in part by the Department of Medicine, University of Toronto; the Toronto Rehab Foundation; and the Canadian Institutes for Health Research.
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