Sunday, February 26, 2006 t SA

MEN'S HEALTH

Prostate-cancer study suggests new approach

• The finding in nearly 50,000 men indicates that early treatment is better than so-called watchful wait­ ing, which has been the norm for elderly patients with the disease.

By THOMAS H. MAUGH II LOS ANGELES TIMES

It is better to treat prostate cancer in elderly people aggressively rather than wait and watch for signs of progression as is commonly done, according to a study that might change the care for ma­ ny victims of the deadly disorder.

Surgery or radiation therapy in elder­ ly men increases survival by at least 30 percent, raising median survival from 10 years to more than 13 years, researchers reported Saturday at a symposium in San Francisco.

The finding in nearly 50,000 men "challenges long-held beliefs about prostate-cancer treatment," said Dr. Paul Lange of the University of Washington, by suggesting that treatment is better than so-called watchful waiting. Lange did not participate in the study.

"It's a wonderful paper that validates what many of us have believed for a long time," said Dr. Mark Kawachi, director of the prostate cancer center at City of Hope National Medical Center in Duarte, Calif. "Age, in and of itself, is not a definitive determinant of whether you should be excluded from treatment [for prostate cancer]."

Prostate cancer is the most common type of cancer among men, with more than 234,460 cases diagnosed in the United States this year and about 27,350 deaths, according to the American Can­ cer Society. It is primarily a disease of the elderly, with abbut two-thirds of pa­ tients over 65.

But there is an "incredible controver­ sy" over how to treat those older pa­ tients, said Dr. Yu- Ning Wong of the Fox

Chase Cancer Center in Philadelphia, who led the new study. While it is clearly beneficial to treat younger men with the disease, many oncologists put off treat­ ment of older ones on the assumption that most prostate cancers are slow growing.

They reason that the victim is likely to die from some other cause before the prostate cancer becomes a serious prob­ lem.

Wong's study is the first to compare treatment and no treatment in this age group. It is an observational study, so its results cannot be considered defmitive, but the findings should provide guid­ ance to physicians and patients who are unsure how to proceed.

"There is a misconception that pros­ tate cancer is universally an innocuous disease of the elderly," said Dr. Howard Scher, chief of genitourinary oncology at the Memorial Sloan-Kettering Cancer Center in New York. With Wong's and other studies, "We are clearly seeing that is· not the case."

Wong's team studied Medicare re­ cords for 48,606 men between 65 and 80 who had survived fora year after a pros­ tate cancer diagnosis. All were diag­ nosed between 1991 and 1999, with a me­ dian age of 72 at diagnosis.

A total of 19,948 men received radia­ tion therapy and 14,098 underwent sur­ gery, while the remaining 14,560 were simply observed.

Wong reported Saturday that only 27

. percent of the men in the watchful wait­ ing group were still alive, with a median survival time - the period in which half the. patients died -,- of 10 years. In con­ trast, 59 percent of those who received either surgery or radiation therapy were still alive, with a median survival time of 13 years and growing.

The benefit of treatment was appar­ ent even among men who were 75 to 80 years old at the time of diagnosis.