The surgery to remove the prostate, radical prostatectomy, is a little too risky for men that are in their 70s and 80s. When these men are found to have the early stages of prostate cancer, they will have three options to choose from.
The first option is they can wait to see whether this usually slow-moving cancer will become a problem. This type of observation is called conservative therapy or watchful waiting. The second option is to undergo radiation therapy and suffer its side effects. The third option is to undergo androgen-deprivation therapy: hormonal drugs such as Lupron, Eligard, Viduar, and Zoladex, or undergo surgery (orchiectomy) that will cut off the production of the male hormones.
Older men that are in the United States often opt for stand-alone hormone therapy, even thought there is really no proof that it is really helpful. One of the hormone therapy's most obvious side effects is sexual dysfunction. According to recent studies, the greater concern now with hormone therapy is linking the androgen deprivation therapies to heart disease, diabetes, bone fractures, and a reduction in muscle mass.
The most recent study on the hormone therapy strongly suggests that this type of therapy offer elderly men no benefit to justify these serious risks. Grace L. Lu- Yao Ph.D., MPH, which is from the University of Medicine & Dentistry of New Jersey, and her colleagues collected data from more than 19,000 mean that have been diagnosed with the early stages of prostate cancer at the average age of 77. Out of these men, none of them underwent surgery or radiation treatment for the early prostate cancer. Nearly 8,000 of the men, however, did decide to go with androgen deprivation therapy.
Lu-Yao said, "The reason patients want this is they want something that will improve their quality of life or their survival. But hormone therapy has a detrimental effect on quality of life. And we cannot find any survival benefit for these men in their 70s with very early-stage cancer."
So now we have to ask, why do so many men choose to undergo this unproven treatment that now seems to do more harm than it does good?
Otis Brawley, M.D. and chief medical officer for the American Cancer Society says that it is because it is just an American phenomenon. One of the problems is that when a man finds out that he has early stages of prostate cancer, both he and his physician feel it is necessary to do something. Unfortunately, the result in the end is that the number of men that should get conservative therapy end up getting some kind of intervention.
Brawley and Lu-Yao both suggest that these elderly men would have done just as well if their cancer had never been found. Brawley also notes that many of these men would have likely underwent continued prostate cancer screenings with PSA tests. The other men probably had possible prostate abnormalities that would have been detected by a urologist.
No matter how they got to their conclusions about their cancers, all of these men must have agreed to undergo prostate biopsies. Also, they may have not have been fully informed and could have come to the wrong decision, says the head of urology at New York's Mount Sinai School of Medicine, Simon Hall, MD.
"You have to have a discussion with an older man before he has a prostate biopsy. You have to ask them, 'Do you really want to open Pandora's Box?' Most patients with localized prostate cancer are not going to die from their disease in the first 10 years anyway. It is a legitimate question whether to screen patients this old, and whether urologists should biopsy older patients based on just a knee-jerk reaction."
Hall also noted that he would only treat a very few men with hormone therapy alone. A lot of the elderly men are at a very low risk and really don't need any treatment at all. It seems that the hormone therapy would make no difference so why put these men through the side effects or cost?
All of these experts have noted that the finding of the current study do not apply to the younger men who might receive androgen-deprivation therapy in combination with radiation or surgery. These such men may actually benefit from this type of hormone therapy.
