New Treatment Options for Older Prostate Cancer Patients?

For older prostate cancer patients, treatment is often minimal. But a new study suggests adding more therapies to the mix may be helpful.

Prostate Cancer

Prostate cancer is the most common non-skin cancer in men; there will be an estimated 220,800 new cases of the disease in 2015, according to the American Cancer Society.

Typical signs of the disease include change in flow or frequency of urination, although other conditions can also cause these symptoms. Prognosis depends on the patientís age at diagnosis, how advanced the disease is, and whether itís the first diagnosis or a recurrence. Fortunately, most men do not die from prostate cancer.

Treating Prostate Cancer

Prostate cancer is generally treated with some combination of chemotherapy, radiation, hormone therapy, and, when appropriate, surgery to remove local (non-spreading) cancers. In men who donít have symptoms, or who have certain medical conditions, sometimes it makes sense to watch prostate cancer closely and treat it only if the tumor changes or the patient begins experiencing symptoms.

Until recently, patients 75 and older often received just Androgen-Deprivation Therapy (ADT). This hormone therapy stops the production of testosterone, a male hormone, or keeps it from affecting cells in the prostate. (Testosterone feeds prostate cancer cells, which helps them grow.) ADT alone does not cure prostate cancer and can cause serious side effects, including hot flashes, impaired sexual functioning, and bone weakness.

Notably, many prostate cancer patients are older: More than 65 percent of prostate cancers are diagnosed in patients over 65, notes the The Prostate Cancer Foundation. In fact, a 70 year-old man has a 7.52 percent chance of developing the disease within 10 years, according to the National Cancer Institute.

Why has ADT alone been the primary form of treatment for these older patients? As Blaine Kristo, MD, an urologist at Mercy Medical Center in Baltimore explains, "Many older men with high-risk versions of prostate cancer are treated differently than younger men. They may only receive ADT and no local therapy [radiation or cryotherapy (freezing the prostate)], based on the belief that their life expectancies were not long enough to warrant the risks of radiation."

New Research, More Options

But more aggressive treatment may be warranted: A recent study in the Journal of Clinical Oncology has found that adding radiation therapy to ADT leads to better outcomes in older men with locally advanced prostate cancer (cancers that have begun spreading into nearby tissue) or aggressive tumors (which have not yet spread, but are fast growing and dangerous). The results support those found in other studies.

What does this mean? "In many patients older than 75, simple hormone treatment for aggressive prostate cancer may not be the best treatment," Kristo says. "If patients are otherwise healthy, they should have a thorough discussion with their physician about receiving radiation treatment as well."

Blaine Kristo, MD, reviewed this article.

Sources

Blaine Kristo, MD. Interview with author, February 6, 2015.

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"Understanding Prostate Cancer: Prostate Cancer Risk Factors." Prostate Cancer Foundation. Page accessed March 13, 2015.

"Table 23.10 Cancer of the Prostate (Invasive)." National Cancer Institute/Surveillance, Epidemiology, and End Results Program (SEER). August 2014.

Bekelman, Justin E., Nandita Mitra, Elizabeth A., Handorf, Robert G. Uzzo, Stephen A. Hahn, Daniel Polsky, and Katrina Armstrong. "Effectiveness of Androgen-Deprivation Therapy and Radiotherapy for Older Men With Locally Advanced Prostate Cancer." Journal Of Clinical Oncology . Published ahead of print on January 5, 2015 as 10.1200/JCO.2014.57.2743.

"Prostate Cancer Treatment (PDQģ)." National Cancer Institute. Last Updated September 12, 2014.

"Hormone Therapy." Prostate Cancer Foundation. Accessed February 24, 2015.

Shumway, Dean A. and Daniel A. Hamstra. "Ageism in The Undertreatment of High-Risk Prostate Cancer: How Long Will Clinical Practice Patterns Resist the Weight of Evidence?" Journal Of Clinical Oncology. January 5, 2015, Doi:10.1200/JCO.2014.59.4093JCO

Sridharan, S., and P. Warde. "The Importance of Local Control in High-Risk Locally Advanced Prostate Cancer." Current Oncology 2012 19, Supplement 3:S6-S12.