Prostate cancer: Seniors over 70 frequently undertherapied

The diagnosis of prostate cancer is no longer a death sentence. If the disease is detected in time by means of PSA test, ultrasound and scanning, it can be cured in many cases. Although prostate cancer is widespread, especially at a later age, men who have reached the age of 70 regularly fall out of the precautionary raster. Dr. Stephan Neubauer, a urologist at the West German Prostate Center, believes that the decision as to whether the patient receives therapy or not is often based too heavily on the age of the patient,"wrongly". The general recommendation is that the blood test for determining the prostate specific antigen (PSA) in patients over seventy years of age should only be carried out if there are symptoms indicating a tumor. This is justified by the fact that prostate cancer is a slow-growing cancer and therefore most older men do not experience the final stage of age or health-related conditions anyway. "A fatal error," criticizes Neubauer. Nowadays, seniors even beyond the age of seventy are still in the middle of life, are physically active, interested in a variety of things and enjoy good health ". The majority of his over 70 year old patients have an average life expectancy of at least 10-15 years, according to the Cologne urologist. Why should early detection and, if necessary, effective therapy be avoided? 

Elderly patients often receive only hormones or no treatment at all That older prostate cancer patients actually receive curative (healing) therapy such as radiation, brachytherapy or surgery less often than their younger fellow sufferers, a recent study1 could now prove. Instead, men of higher age are more often treated with hormone therapy or controlled waiting (Active Surveillance). It is not uncommon for men over 70 years of age to be diagnosed with more aggressive forms of the tumour than previously thought,"said Neubauer. These are tumours that grow very quickly, form metastases and can lead to death if detected too late. However, when very elderly men with more aggressive high-risk tumours are treated with established therapies, the mortality rate decreases by almost half, as recently published in the prestigious British Journal of Urology. 2 

We can not only orient ourselves to the age of the patients, but must also consider other factors such as the general state of health, physical and mental agility,"says Neubauer. Once the decision for a therapy has been made, the focus should be on gentle treatment methods. Internal radiation, 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 have a radiation effect on the prostate carcinoma for months,"said Neubauer. The tumor tissue is destroyed from the inside by the high-dose radiation. Neighbouring organs such as the intestines, bladder and ureter are spared. This is noticeable in the quality of life and satisfaction of the patients, emphasizes 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."

  1. Bechis SK, Carroll PR, Cooperberg MR. Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol. 2011 Jan 10;29 (2): 235-41 Epub 2010 Dec 6.
  2. 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.

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