Octogenarians not too old for cancer surgery; Mayo Clinic Cancer
Center finds age not automatic barrier to men with prostate cancer
ROCHESTER, Minn., Nov. 27 /U.S. Newswire/ -- Mayo Clinic Cancer
Center researchers have found that a radical prostatectomy can be a
viable option for select octogenarian patients. The findings, which
run counter the conventional practice of generally avoiding
surgeries for individuals over 80 years old solely based on age, are
available today in Urology.
"Increased life expectancy and generally higher levels of wellness,
as well as safer forms of anesthesia and less-invasive surgical
techniques, have made it possible for older adults to safely and
effectively have surgeries traditionally not offered over a certain
age," says Michael Lieber, M.D., Mayo Clinic urologist and the
study's senior investigator.
"We
didn't think that using age as the deciding factor was a valid
argument for not performing a radical prostatectomy, and we proved
that it is a safe option for some men."
One in six men will eventually be diagnosed with prostate cancer,
reports the American Cancer Society, and more than 27,000 men will
die from prostate cancer this year in the United States. A variety
of treatment options exist for this traditionally slow- growing
cancer, including hormone therapy, chemotherapy, radiation therapy,
cryotherapy, surgery and expectant management ("watchful waiting").
JAMA reported in 2000 that urologists typically offer a radical
prostatectomy to patients with more than 10 years of life
expectancy, and do not offer this surgical option to patients older
than age 70 to 75. Another study, published in The New England
Journal of Medicine in 2005, showed that radical prostatectomy
significantly reduces overall mortality, local disease progression,
and distant metastases; and is associated with less hormone
treatment and palliative radiation.
In the Mayo study, Lieber's team reviewed records for the 19
patients age 80 or older who underwent radical prostatectomy at Mayo
Clinic from 1986 to 2003. They found that while reasons for the
radical prostatectomy varied, usually the patients requested or even
demanded the surgery. At the time of surgery, the average patient
age was 81 (range was 80 to 84), the average prostate-specific
antigen (PSA) level was 10.2 nanograms per milliliter (normal is 0
to 4 ng/ml), and the average American Society of Anesthesiologists
score (relates general health and risk of death) was 2.4 out of five
(worst).
Thirteen had pathological stage pT3 (pT4 being the worst) disease or
a Gleason score (tumor aggressiveness measurement system) of seven
or more (out of 10). "These were patients with very aggressive forms
of prostate cancer," says R. Houston Thompson, M.D., the study's
primary author. "Had our surgeons not removed the cancer, risk of
death or need for palliative care (radiation, hormones, etc.)
certainly could have become an issue."
The researchers say the decision to perform a radical prostatectomy
for each man was reasonable, and the data agree. Of the 19 patients,
14 remained continent, none died within a year of surgery or from
prostate cancer, and the 10-year survival rate was similar to that
observed in healthy patients 60 to 79 years old undergoing a radical
prostatectomy. Only three of the 19 died from any cause within 10
years of the surgery.
"Aging is a highly individualized process," says Lieber. "Decisions
should be made on a case-by-case basis, but we feel surgery can be
offered to very healthy, active octogenarians with localized
prostate cancer with satisfactory results."
Jeffrey Slezak and W. Scott Webster, M.D., also collaborated on this
study.
For more information on prostate research at Mayo Clinic Cancer
Center, see
http://cancercenter.mayo.edu/mayo/research/prostate_program
To learn about treatment of prostate cancer at Mayo Clinic visit
http://www.mayoclinic.org/prostate-cancer.
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