Early Stage Prostate Cancer Unlikely to Affect Survival
Abstract & commentary
By Mary Elina Ferris, MD, Clinical Associate Professor, University of Southern California. Dr. Ferris reports no financial relationship to this field of study.
Synopsis: Older men with early stage prostate cancer had survival similar to those without cancer; for two-thirds of these men, cardiovascular diseases and other cancers were more likely to cause death than prostate cancer.
Source: Ketchandji M, et al. Cause of death in older men after diagnosis of prostate cancer. J Am Geriatr Soc 2008 Nov 18; Epub ahead of print.
Using a population-based cancer registry (SEER) matched with Medicare data, 99,388 men aged 66-84 diagnosed with prostate cancer between 1992 and 2002 were compared to age-matched noncancer controls. Early stage cancers were identified in 81% with clinical Stage T1 or T2 tumors, and 72% with low- to moderate-grade tumors.
Comparison of survival curves for ages 65-74 with Stage T1 or T2 tumors closely resembled the survival of patients without cancer for the first 7-8 years, and then became worse than the survival of men without cancer. For men aged 75-84, T1 to T3 tumors had survival rates that closely overlapped each other and the cancer-free comparison group. Only Stage T4 prostate cancers had a clear effect on survival rate for men aged 75-84.
Overall, cardiovascular disease had similar 5-year mortality (7.2%) for the cancer patients compared to mortality from prostate cancer itself (7.7%). For men with Stage T1 or T2, low- or moderate-grade tumors (59% of all cases), mortality from heart disease was 6.4% compared to 2.1% for prostate cancer, vs 3.8% from other cancers. Even with more disseminated prostate cancer, men with low- or moderate-grade tumors (60.5% of men with Stage 3 cancer) experienced higher rates of death from cardiovascular disease (5.2%) than from prostate cancer (4.0%).
Commentary
Prostate cancer is the most common form of non-skin cancer diagnosed in men, and 75% of those cases occur in men aged 65 and older. Once cancer is diagnosed, it tends to be the predominant medical concern, yet these interesting findings suggest that comorbid medical conditions are more of a survival threat. These data come after the advent of screening with prostate-specific antigen, suggesting that early detection of prostate cancers may be altering the survival curves. Furthermore, decisions about the aggressiveness of cancer treatment should consider comorbid diseases, since androgen-deprivation therapy, used to treat even early stage prostate cancer, may increase the risk of cardiovascular events and exacerbate diabetes mellitus.1,2 Ideally the medical care of older men with prostate cancer should involve consideration of their other chronic conditions, and decisions about early stage prostate cancer treatment should be made together with the patient's primary care physician.
References
1. D'Amico AV, et al. Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions. J Clin Oncol 2007;25:2420-2425.
2. Keating NL, et al. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 2006;24:4448-4456.
Older men with early stage prostate cancer had survival similar to those without cancer; for two-thirds of these men, cardiovascular diseases and other cancers were more likely to cause death than prostate cancer.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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