Prostate Cancer in Older Men: Are We Treating Too Aggressively?
By Dr. David Samadi
A growing number of older men with prostate cancer are undergoing aggressive treatments like surgery and radiation therapy, even when these interventions are unlikely to extend their lives or improve outcomes. A recent analysis published in JAMA Internal Medicine highlights this concerning trend, revealing the potential risks of overtreatment in prostate cancer patients with limited life expectancy, urging caution in treatment decisions.
Understanding the Findings
Prostate cancer is the second-most common cancer in the U.S., with one in eight men receiving a diagnosis—often around the median age of 67. Many cases involve slow-growing tumors confined to the prostate gland that pose minimal risk to a patient’s life. For these low-risk cancers, medical professionals typically recommend “active surveillance,” a conservative approach involving regular monitoring through tests and exams to track disease progression.
“Active surveillance has become the preferred approach for men with low-risk prostate cancer,” explains Dr. Timothy Daskivich, director of Urologic Oncology Research at Cedars-Sinai and lead author of the study. “It allows patients to avoid the side effects of treatments like surgery or radiation, which can cause urinary incontinence, erectile dysfunction, and other complications.”
However, the study shows that men with limited life expectancies who are diagnosed with intermediate- or high-risk prostate cancer are increasingly receiving aggressive treatments instead of conservative management. This shift contradicts clinical guidelines, which suggest that men unlikely to live long enough to benefit from these therapies should avoid them due to their significant risks.
The Data Behind the Trend
The research team analyzed records from over 243,000 men in the Veterans Affairs health system diagnosed with localized prostate cancer between 2000 and 2019. The findings revealed some concerning patterns:
- For men with life expectancies under 10 years, aggressive treatment for low-risk cancers dropped from 37.4% to 14.7%, reflecting progress in avoiding overtreatment.
- However, for intermediate-risk cancers in the same group, aggressive treatments increased from 37.6% to 59.8%.
- Among men with life expectancies under five years, aggressive treatments for high-risk cancers surged from 17.3% to 46.5%.
Notably, approximately 80% of these treatments involved radiation therapy, which often comes with significant side effects and offers limited benefit for those with shorter life spans.
A Call for Smarter, Personalized Decision-Making
Dr. Daskivich emphasizes the importance of integrating life expectancy into treatment decisions. “We were surprised to see so many patients with limited life expectancies undergoing treatments that take years to yield significant survival benefits,” he said.
To address this, the research team proposes a “trifecta” approach to help patients and clinicians make more informed decisions. This involves discussing:
- The likelihood of dying from prostate cancer with treatment.
- The possibility of dying without treatment.
- How these probabilities align with the patient’s life expectancy and personal goals.
This framework encourages clinicians to focus on personalized care, ensuring patients fully understand their options. Some men may choose aggressive treatment despite a low likelihood of benefit, while others may opt for less invasive approaches after considering the risks and their circumstances.
Empowering Patients with Knowledge
“Every patient is unique, and averages or statistical models can’t predict individual outcomes,” says Dr. Daskivich. “But by prioritizing open, informed discussions, we can give patients the tools to make the best decisions for their situation.”
Ultimately, this study reminds us that while advances in prostate cancer treatment are lifesaving for many, a one-size-fits-all approach is rarely appropriate. By aligning care with each patient’s needs and longevity, the medical community can improve outcomes while avoiding unnecessary harm.
Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of Prostate Cancer, Now What? and The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncolo gy and prostate cancer 911.