Over-treatment of elderly men with prostate cancer may decrease their quality of life without extending its duration.
The study's findings were published in the peer-reviewed journal JAMA Internal Medicine.
Prostate cancer is the second most common cancer, surpassed only by breast cancer.
In most patients, tumors grow slowly, are localized to the prostate, and are unlikely to threaten their lives. Instead of immediate treatment, these low-risk patients may be placed under "active surveillance," which involves regular check-ups and tests to ensure that the disease is not progressing.
Conservative treatment, which includes active surveillance or a watchful waiting approach, is also recommended for men with a limited life expectancy who are unlikely to live long enough to benefit from aggressive local treatment, even in cases of high-risk cancer. However, an opposite trend is observed for these men: men with limited life expectancy and intermediate to high-risk cancer are less likely to receive conservative treatment and more likely to undergo aggressive local treatment through surgery or radiation.
"We found an astonishing pattern," said the lead researcher. "Patients with prostate cancer who have a life expectancy of less than five or ten years were subjected to treatments that may take up to ten years to significantly improve their survival odds, despite recommendations against such treatment."
In the study, researchers analyzed medical data from 243,928 men in the Veterans Affairs healthcare system who were diagnosed with localized prostate cancer between 2000 and 2019.
Among patients with a life expectancy of less than 10 years, the proportion who underwent surgical or radiation treatment for low-risk prostate cancer instead of active surveillance decreased from 37.4% to 14.7%, while the percentage of patients receiving treatment for intermediate-risk disease increased from 37.6% to 59.8%.
According to the researchers, addressing the issue of overtreatment for prostate cancer patients with increased risk and limited life expectancy requires a multifaceted approach that includes more accurate assessments, education, and consideration of life expectancy in decision-making. The scientists proposed a "trifecta" method to inform patients about cancer prognosis. This method involves a discussion between the doctor and patient about the likelihood of death from cancer with and without treatment at the patient's expected life expectancy endpoint. Such an approach allows for a personalized assessment of cancer risk relevant to each patient.
"Our goal is to encourage clinicians to make life expectancy a part of the discussion about the best treatment options so that prostate cancer patients with limited life expectancy can make informed choices," says the lead researcher. "A patient can receive this information and decide on surgery or radiation therapy, despite the limited likelihood of benefit. Another patient may choose a different path."
Every individual is unique, and statistical averages regarding life expectancy, treatment effectiveness, and cancer risk cannot confidently predict outcomes. However, patients should be given the opportunity to make informed decisions based on the most comprehensive information available.