Prostate cancer with 75
Who benefits from a treatment - who does not?
Is it worthwhile for over-75s to treat prostate cancer, or are seniors better advised to wait and see how to proceed? In addition to age, experts demand that the health condition, the form of the tumour and the individual needs of patients be taken into account in the therapy decision. Prostate cancer is not called the cancer of the elderly man for nothing.
Although prostate cancer is widespread, especially in older people, men who have reached the age of 70 regularly fall out of the precautionary grid. Also the decision whether the patient receives a "healing" treatment or not is unfortunately still often made solely dependent on the age of the patient,"complains Dr. Stephan Neubauer, urologist at the Westdeutsche Prostatazentrum in Cologne.
Life expectancy does not only depend on age, but also on a number of additional factors, as several studies have shown impressively. For example, chronic accompanying illnesses, physical fitness but also independence and mental agility play an essential role in determining how many years a patient still has ahead of him or her1."Many seniors are still in the middle of their lives beyond the age of 75, are physically active, interested in a wide range of activities and enjoy good health," says Neubauer from daily practice. The Cologne urologist therefore attests an average life expectancy of at least 10-15 years to the majority of his over-75 year old patients. So why should an effective therapy be dispensed with here?
Patients over the age of 70 rarely receive curative therapy
The Society for Geriatric Oncology (SIOG) also recommends that healthy elderly people should receive the same treatment as younger prostate cancer patients. However, this is not the case in practice, as shown by a large number of studies1, according to which older patients with localized prostate cancer actually receive curative (healing) therapies such as brachytherapy, radiation or surgery more rarely than their younger fellow sufferers. Instead, men of higher age are more often treated with hormone therapy or controlled waiting (Active Surveillance).
The shot can be fired backwards,"says Neubauer. More often than previously assumed, more aggressive forms of the tumour are also diagnosed in men over 75 years of age. These are tumours that grow very quickly, form metastases and can lead to death if detected too late. However, if older men with high-risk tumors are treated with the established therapies, the mortality rate decreases by almost half, as recently published in the renowned British Journal of Urology2.
Focus on gentle treatment methods
The aim of any prostate cancer therapy should be to avoid possible quality of life restrictions caused by the disease and to prolong patients' lives. Once the decision for a therapy has been made, the focus should therefore be on gentle treatment methods,"emphasizes Neubauer. Internal irradiation, known as brachytherapy, is particularly suitable for this purpose. Under constant ultrasound control, up to 80 very small radiation sources (seeds) are inserted into the prostate gland. The seeds remain in the patient's body and develop their radiation effect on the prostate carcinoma for months. The tumor tissue is destroyed from the inside by the high-dose radiation. Neighbouring organs such as the intestines, bladder and urethra are spared. This is noticeable in the quality of life and patient satisfaction, according to the Cologne urologist. His conclusion:"It must never be allowed to be the case that old age is a compelling reason not to treat prostate cancer."
Rockwood K, StadnykK, McKnight C et al: A letter clinical instrument to classify frailityin elderly people, Lancet 353.205-206;1999
Brassell SA, et al.: Prostate cancer in men 70 years old or older, indolent or aggressive: clinico-pathological analysis and outcomes. J Urol. 2011 Jan; 185 (1): 132-7 Epub 2010 Nov 12.