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ASCO GU 2008 - Are We Under-Treating The Elderly Male?

UroToday.com - Dr. Armstrong, a primary care internist and epidemiologist at the University of Pennsylvania presented on prostate cancer in the elderly population. The risk of developing CaP during the next 15 years for a man at age 50 is 50/1,000 compared to 117/1,000 for a 65 year old man. Dr. Armstrong addressed the heterogeneity of CaP. The PCSM is much higher for high risk disease, but still competes with other comorbidities. The life expectancy for a 75 year old man in the US is 10.1 years. Thus many 65 and 75 year old men will live another 15 years. While there is limited randomized clinical data, the Bill-Alexson trial from 2005 shows an overall survival advantage of 7.4% for those undergoing RP compared to watchful waiting.

From the SEER registry, a cohort of men ages 65-80 was identified and presented. 12,000 were observed and 32,000 had treatment. The proportion surviving was higher for treated men, but these men differ for reasons other than just the cancer. It is possible that the untreated men were less healthy, and for example, the treated men were healthier, wealthier, and younger. She explained that a propensity score will account for these other differences. Using propensity score adjustment, there still was a survival benefit for treated men; although this HR was .67 for men age 65-67 compared to 0.74 for men 78-80. For 65 year old men with early stage disease, active treatment would result in 7% PCSM compared to 14% for watchful waiting. In both groups 15% die from other causes. Treatment complications do occur, with erectile dysfunction being the most common for any of the treatments. Erectile dysfunction, however, even occurs in 30% on watchful waiting. She argued to collect prospective registry data on new technologies such as robotic prostatectomy so that outcomes can be better assessed in the future.

Presented at the 2008 Genitourinary Cancers Symposium: February 14-16, 2008, San Francisco, California.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS Professor & Chairman Department of Urology University of California, Davis, School of Medicine Sacramento, CA

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GU ASCO 2008 - Suntem Sub-tratarea Vârstnici Masculin? - ASCO GU 2008 - Are We Under-Treating The Elderly Male? - articole medicale engleza - startsanatate