Prostate cancer may cause neglect of other illness

NEW YORK (Reuters Health) - The majority of men with early-stage. low- or moderate-grade prostate cancer die from causes other than prostate cancer, researchers report in the Journal of the American Geriatric Society. Therefore, prevention and management of other health conditions is important in these patients.

“Once a diagnosis of cancer has been made, it can become the sole focus of medical care,” Dr. James S. Goodwin and colleagues write. “This is understandable, because cancer is typically life threatening and often requires dramatic therapy. But earlier cancer diagnoses, due to screening, and improvements in treatment have been associated with lower cancer mortality,” they note.

“Thus, patients are living longer after a diagnosis of cancer,” to the point where other illness may have a substantial effect on their survival, they point out.

Goodwin, of the University of Texas Medical Branch, Galveston, and colleagues used data from the Surveillance, Epidemiology, and End Results (SEER) Medicare database to assess the outcome of 208,601 men between the ages of 65 and 84 years diagnosed with prostate cancer from 1988 through 2002. Overall, 59.1 percent of the entire group had early-stage prostate cancer with low- to moderate-grade tumors.

The mortality in these patients was similar to that of men the same age without prostate cancer. Among the men with early-stage, low- or moderate-grade tumors, mortality from prostate cancer was 2.1 percent versus 6.4 percent from heart disease, and 3.8 percent from other cancers.

The “substantial effect” of other illnesses on survival and the high mortality rate from causes other than prostate cancer may have important implications, Goodwin’s team notes.

Treatment decisions for localized prostate cancer should consider life expectancy based on age and the contribution of other conditions to the patient’s mortality, they note. Also, the decision to use androgen deprivation therapy, which is now commonly used to treat even early-stage prostate cancer, must be made carefully if another significant illness is present. With this approach, androgen, a male sex hormone that can stimulate the growth of prostate cancer tumors, is blocked.

Overall, the team concludes that older men with early-stage prostate cancer “would be well served by an ongoing focus on screening and prevention of cardiovascular disease and other cancers.”

SOURCE: Journal of the American Geriatric Society, January 2009.