Survival Associated With Treatment Vs. Observation Of Localized Prostate Cancer In Elderly Men

UroToday.com- Without randomized trials of treatment vs. observation in elderly men with prostate cancer (CaP), it has been the assumption that these men will succumb to other causes. According to a report in the December 13, 2006 issue of JAMA, this may not be the case and treatment may decrease the risk of prostate cancer death in these men.

The report studies 44,630 men ages 65 to 80 years with well or moderately differentiated CaP diagnosed between 1991 and 1999. The data regarding this cohort was acquired from the SEER database with linking to patient Medicare claims. Poorly differentiated tumors or locally advanced cancers were excluded due to the high risk for progression. Overall survival was defined as the interval from the date of diagnosis to the Medicare documented date of death. Comorbid variable were also evaluated and factored into the analysis, as they could bias towards observation or an increased probability of treatment related complications.

The patients were divided into 12,608 (28%) in the observation group and 32,022 (72%) in the treatment group. Treatment consisted of surgery or radiation therapy. The study period was 12 years long and 12,302 men (28%) had died; 37% of patients in the observation group and 24% in the treatment group. A proportional hazards model indicated that active treatment was associated with a significant improvement in survival in the overall cohort. This remained so after adjusting for individual co-morbidities. CaP was the cause of death in 314 men in the observation group and 612 men in the treatment group. Median overall survival in the treatment group was 55 months compared to 47 months in the observation group. Treatment was associated with reduced risk of death in men who received either surgery or radiation therapy.

While this report does not replace the need for randomized trials, it does suggest a survival advantage for elderly men with CaP who undergo active treatment. Several ongoing randomized trials are nearing completion and will shed further light onto this dilemma.

Yu-Ning Wong; Nandita Mitra; Gary Hudes; Russell Localio; J. Sanford Schwartz; Fei Wan; Chantal Montagnet; Katrina Armstrong
JAMA 2006; 296:2683-93.

Reviewed by UroToday.com Contributing Editor Christopher P. Evans, MD

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