Aggressive Therapy for Elderly Prostate Ca Patients Is On the Rise

LAS VEGAS--Use of aggressive therapy in elderly prostate cancerpatients has increased despite a lack of clear evidence of benefit,Michigan investigators reported at the American Urological Associationmeeting.

The researchers found that, in metropolitan Detroit, expendituresfor aggressive therapy in elderly prostate cancer patients rose750% in one decade, primarily due to increased use of radiotherapyin these patients.

The conclusions are based on an analysis of data from the DetroitCancer Surveillance System, a component of the National CancerInstitute's Surveillance Epidemiology and End Result (SEER) program.

The data show double-digit increases between 1973 and 1992 inthe use of radical prostatectomy and radiotherapy for localizeddisease in men over age 75.

Mirroring national trends, the incidence of prostate cancer increasedsubstantially in the period covered by the study. The largestincrease in the Detroit area involved men aged 75 to 84, saidJames Montie, MD, formerly of Wayne State University, Detroit,and currently professor of surgery at the University of Michigan.

From 0.6 to 31.5 per 100,000

From 1973 to 1977, the use of radical prostatectomy for localizeddisease in men over age 75 averaged 0.6 per 100,000 men over age75 in the general population (a single procedure during that timeperiod). By 1992, the rate had increased to 31.5 per 100,000 (51procedures between 1988 and 1992). Use of radiotherapy in theelderly prostate cancer population increased even more duringthis time frame, from 55 to 605 per 100,000.

From another statistical perspective, radical prostatectomy wasemployed in 0.1% of elderly patients with localized disease from1973 to 1977, rising to 1.7% between 1988 and 1992. Use of radiotherapyincreased from 5.6% of men over age 75 with localized prostatecancer in 1973 to 35.8% in 1992.

The data showed that use of hormonal therapy in elderly patientswith localized prostate cancer decreased during the time periodevaluated, but Dr. Montie questioned the reliability of the data."I think a good deal of outpatient hormonal therapy is notcaptured by this database," he commented.

An Obvious Question

The findings raise an obvious question, he said: "Is thisdegree of aggressive treatment of probably asymptomatic and PSA-basedlocalized prostate cancer excessive?"

The question cannot be answered from the available data, Dr. Montiesaid, and getting any kind of answer will be challenging. "Weall know how difficult it will be to prove a benefit of therapyfor localized disease in a younger age group," he said. "Imaginehow much more difficult it will be to prove such a benefit inolder patients."