How should we treat advanced prostate cancer in older men?
Most of the controversy about the treatment of prostate cancer focuses on the early diagnosis and treatment of early stage prostate cancer in patients. The question of whether PSA testing and subsequent treatment based on this helps to save lives remains unanswered. However, not all prostate cancer is early stage, and some patients develop locally advancer prostate cancer. This disease stage is characterized by cancer that has spread outside the prostate, and is locally advanced. Patients, who develop this, will be more likely to develop metastatic disease and may ultimately die from the disease.
The most common treatment (40%) for elderly patients with this stage disease is usually the administration of medications that decreases the testosterone levels. This deprives the prostate cancer cells of the substance that allows for its growth. Eliminating this hormone will slow down but not eradicate the cancer. Surgical intervention is not effective for the patients who have advanced disease, as it will not completely eradicate the tumor
Recently there have been several studies that have addressed this issue. The question that was asked was whether the addition of radiation therapy to the standard hormone administration will make any difference in prolonging survival for the older men. The University of Pennsylvania has recently reported that the use of this combination was effective
Patients between ages 76-85 who had advanced prostate cancer were given the combination of radiation and hormones and the outcomes were compared with those of the patients who only received the radiation therapy. These researchers showed that in of patients between the ages of 65- 75 there was a reduction in prostate cancer deaths by 57%. Similarly in patients between 76-85, there was a 49% decrease.
This study offers new hope for those patients who have advanced prostate cancer. It clearly gives the treating Urologist other options, than what has been the standard knee jerk response to only using hormones alone. Patients in this age group may want to inquire about this form of treatment and seek a consultation with a radiation oncologist.
Jay Motola, MD, is a board-certified urologist and attending physician, Department of Urology, Mount Sinai West, and Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai. Dr. Motola is a summa cum laude, Phi Beta Kappa graduate of Boston University, and earned his medical degree at the State University of New York at Stony Brook.