Men who have life expectancies of less than 10 years often receive aggressive therapy for low- to intermediate risk prostate cancer (PCa), although the risks likely outweigh the benefits, according to a large, nationally-representative study. Radiation was by far the most common treatment, followed by surgery.
Guidelines generally discourage aggressive treatment in such men. Randomized trial data also suggest that significant differences in survival between watchful waiting and aggressive therapy do not develop until 10 years after treatment.
“Because of their low likelihood of 10-year survival, these men are unlikely to live long enough to substantially benefit from aggressive treatment, but they incur its associated side effects and financial burden,” lead investigator Timothy J. Daskivich, MD, MSHPM, of the University of California Los Angeles, and colleagues wrote in Cancer. The researchers said they hope this information will promote greater awareness of the role of life expectancy in treatment decision-making. Some side effects of aggressive treatment include erectile dysfunction, urinary incontinence and bowel problems.
Overtreatment appears to be largely driven by overestimation of life expectancy. Although clinicians have life tables based on age, there is no widely accepted method for determining life expectancy that incorporates both age and health status. Patients may also seek aggressive treatment for peace of mind.
For the study, the researchers looked at a sample of 96,032 men aged 66 years and older with early-stage PCa from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Life expectancy calculations were based on age and mortality for other comorbid conditions (assessed from claims data).
Overall, life expectancy was less than 10 years for 50,049 men (52%). Among those, treatment was aggressive for 68% of men aged 66 to 69, 69% aged 70 to 74, 57% aged 75 to 79, and 24% age 80 and older.
Overuse of radiation therapy may be a consequence of patient evaluation that is less than rigorous, especially when compared with surgery, the researchers suggest.