Cedars Sinai Study Questions Aggressive Prostate Cancer Treatment for Some Men

Increased Overtreatment of Prostate Cancer in Older US Men

A recent study by Cedars-Sinai has found that an increasing number of older US men with prostate cancer are undergoing treatments that carry risks of side effects that can significantly reduce the quality of life without extending life.

Research Findings

The study analyzed medical data on 243,928 men in the Veterans Affairs health system who were diagnosed with localized prostate cancer between 2000 and 2019. The researchers found that among patients with average life expectancies of less than 10 years, the proportion who underwent treatments such as surgery or radiation for low-risk prostate cancer rather than receiving active surveillance decreased from 37.4% to 14.7%. Treatment for intermediate-risk disease increased from 37.6% to 59.8%, while treatment for high-risk disease increased from 17.3% to 46.5% among patients with average life expectancies of less than five years.

Implications of Overtreatment

The study highlights the issue of overtreatment in higher-risk patients with limited longevity. The investigators found that roughly 80% of men who were overtreated were treated with radiation therapy. This means that many men are experiencing side effects such as impotence, incontinence, and bowel problems that can significantly reduce their quality of life without extending their life expectancy.

Solutions and Recommendations

The study’s corresponding author, Dr. Timothy Daskivich, emphasized the need for a multifaceted approach to address the issue of overtreatment. He proposed a “trifecta” method for communicating cancer prognosis to patients, including discussions about the likelihood of dying from the cancer with treatment vs. without treatment at the endpoint of the patient’s life expectancy.

Conclusion

The study’s findings underscore the importance of taking into account a patient’s life expectancy when deciding on the best treatment options. By communicating cancer prognosis to patients in a clear and transparent manner, clinicians can help patients make informed decisions about their care. This approach can help reduce the risk of overtreatment and improve the quality of life for patients with limited life expectancies.

FAQs

1. What is the significance of the study’s findings?
   The study highlights the issue of overtreatment in higher-risk patients with limited longevity, which can have significant consequences for patients’ quality of life.
2. What is conservative management, and why is it important?
   Conservative management refers to the use of active surveillance or watchful waiting in patients with limited life expectancies or low-risk cancers. It is important because it avoids unnecessary treatment and its potential side effects.
3. What is the goal of the proposed “trifecta” method?
   The goal of the proposed “trifecta” method is to encourage clinicians to incorporate life expectancy into decision-making and communicate cancer prognosis to patients in a clear and transparent manner.
4. What are the consequences of overtreatment for patients?
   The consequences of overtreatment include side effects such as impotence, incontinence, and bowel problems that can significantly reduce patients’ quality of life without extending their life expectancy.