Age alone should not be a barrier to men getting surgery for prostate cancer, according to a new Canadian study.
The research, published in today's edition of the Journal of the National Cancer Institute, challenges the common practice of dissuading men over the age of 70 from having surgery because of the perceived risks.
"Age bias is a strong term, but it's an appropriate way of explaining why there is widespread undertreatment of older men with prostate cancer," Dr. Shabbir Alibhai, a geriatric oncologist at University Health Network in Toronto, said in an interview. "All things considered, age shouldn't be a big factor."
Rather, Dr. Alibhai said, the strongest predictor of whether a man will have complications after prostate surgery is other medical conditions and, in particular, a history of heart disease.
By focusing too narrowly on age, rather than the overall health of patients, surgeons are denying treatment to many older men and, at the same time, placing many younger patients (notably those with heart disease) at undue risk, the study found.
About one-third of men with prostate cancer undergo prostatectomy (removal of the prostate) for treatment of cancer. But, in men over the age of 70 -- those most likely to have cancer -- the surgery rate is less than 5 per cent.
A recent survey found that seven in 10 Canadian urologists believed that age 70 is the upper limit for performing a prostatectomy. The new study, however, revealed that older men have rates of postsurgical complications and death virtually equal to those of younger men with similar cancers.
"Starting at age 65, there's a drop-off and by 75 almost nobody is getting surgery," Dr. Alibhai said. "There's no good reason for that."
To conduct the study, researchers reviewed the files of 11,010 men who underwent prostate surgery in Ontario between 1990 and 1999. Overall, they found that 20 per cent of men experienced complications and 0.5 per cent died in the month following surgery.
Among the oldest group, men 70 to 79 years of age, the complication rate was 26 per cent and the death rate 0.66 per cent. (The data allowed researchers to examine only surgical complications, not issues such as impotence and urinary incontinence, which are common complications of prostatectomy and are believed to be more likely among older men.)
By comparison, men with heart disease had a three-fold increase in mortality and those who had a stroke previously had an eight-fold increase in risk of death after prostate surgery, regardless of age.
The prostate is a walnut-sized gland that is part of the male reproductive system. Its principal function is to produce seminal fluid. Prostate cancer is the most commonly diagnosed cancer among men. In 2005, an estimated 20,500 men will be diagnosed with prostate cancer and 4,300 will die of the disease, according to the Canadian Cancer Society.
Prostate cancer can be treated with surgery, radiation therapy and hormonal therapy. Because prostate cancer is often slow-growing, "watchful waiting" (monitoring the growth of small tumours but not actively treating them) is also common practice.
Research published earlier this year showed that men who undergo prostatectomy have markedly better outcomes. About 9.5 per cent of those who got surgery and 15 per cent of those in the watchful-waiting group died within 10 years of being diagnosed. But all the benefit appeared to be among men under 65, where the watchful-waiting group had more than double the death rate of the surgery group.
André Picard