Any input "poor prognosis for older men dignosed with prostate cancer?"
February 8, 2018 1:20 PM   Subscribe

Surprised after reading this 2018 article as I understood that the older a man was when diagnosed with PC the less virulent or slower the disease progressed. I realize the article refers to the fact that older men may present and be diagnosed with physical symptoms (or with a negative DRE test?) and not as the result of a high PSA test. Thank you.
posted by Tullyogallaghan to Health & Fitness (4 answers total)
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posted by JimN2TAW at 1:23 PM on February 8, 2018

I think this link is to the same study.

I have read that most men will get prostate cancer if they live long enough; it's seems inevitable for this organ. And many men will be diagnosed with very slow-growing cancers, so surgery has more downsides than upsides, at least in the early stages. There are many forms of cancer, some much more aggressive.
posted by theora55 at 1:51 PM on February 8, 2018

The conclusion of the study seems very bland: Our findings argue against a strong inherent effect of age on risk of prostate cancer death, but indicate that in current clinical practice, old men with prostate cancer receive insufficient diagnostic work-up and subsequent curative treatment.

It may be fair to characterize it as a reminder to take PCa seriously even if the patient is old.

They noted poorer results from these therapies:

deferred treatment
androgen deprivation therapy
radical prostatectomy

So deferred treatment (aka watchful waiting) is not likely to do a lot of good. Androgen deprivation is very hard on the body and could be a factor death from other causes. It's also know to be effective for only a few years. Prostatectomy (surgery) is also a risk for an older patient that may have risks due to heart disease, diabetes, or whatever.

So those therapies all have downsides.

They found better results with radiotherapy. But they did not include with their results a recommendation to prefer radiotherapy.

It's very hard to compare different therapies in PCa because the time line is so long, but when I had my brush with it 20 years ago, the best radiotherapy was almost as effective as surgery. I believe it's gotten better since, while prostatectomy is still pretty much the same.

It's also true that some men get a mix, e.g. hormonal therapy to shrink the tumor before surgery.
posted by SemiSalt at 2:15 PM on February 8, 2018

The study is of Swedish men. So the conclusion that "old men with prostate cancer receive insufficient diagnostic work-up and subsequent curative treatment" applies to Swedish men, only.
posted by beagle at 6:20 PM on February 8, 2018

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