| (PHILADELPHIA) – Recent findings from an observational
study by researchers at the University
of Pennsylvania School of Medicine suggest that men between
65 and 80 years of age who received treatment for early stage, localized
prostate cancer lived significantly longer than men who did not receive
treatment. The study will be published in the December 13th issue
of the Journal of the American
Thanks to better cancer prevention education and the resulting
wide-spread increase in using prostate-specific antigen (PSA) screenings,
more men are being diagnosed with early-stage and low-or intermediate-grade
prostate cancer. Studies have shown that the slow-developing nature
of prostate cancer during its earliest stages makes treatment options,
such as a radical prostatectomy (surgical removal of the prostate)
and radiation therapy, controversial with unpredictable outcomes.
Often, recently diagnosed men of this group were advised to just
“watch and wait” to see how their situation progressed.
“For this study we looked back over the existing data of
a large population of prostate cancer patients, aged 65 to 80, with
small tumors that were at a low or intermediate risk of spreading,”
said senior author Katrina
Armstrong, MD, MSCE, who worked on the study with colleagues
from Penn’s Abramson
Cancer Center, Center for
Clinical Epidemiology and Biostatistics, Leonard
Davis Institute of Health and Economics, and Division
of Internal Medicine, and Fox
Chase Cancer Center. “After accounting for all their differences,
we discovered that the men – who within six months of diagnosis
underwent surgery or radiation therapy – were 31 percent less
likely to die than those who did not undergo treatment during that
Researchers acquired the necessary data for this study from the
Surveillance, Epidemiology, and
End Results (SEER) Medicare database, a population-based cancer
registry which encompasses approximately 14 percent of the US population.
Data was included on 44,630 men, aged 65 to 80, who were diagnosed
between 1991-1999, with prostate cancer and had survived more than
a year after diagnosis. All patients were followed-up until death
or December 31st, 2002, the end of the study. Of the 44,630 men,
32,022 (71.8 percent) were actively treated with either surgery
or radiation therapy during the first six months after diagnosis.
The remaining group of 12,608 (28.3 percent) were classified as
having received “observation” and did not undergo surgery,
radiation or hormonal therapy.
During the 12-years of follow-up, researchers found that the patients
who received treatment had a 31 percent lower risk of death. In
the observation-only group, 37 percent of the patients died whereas
only 23.8 percent of those in the treatment group died.
Since this was not a randomized, controlled study but a retrospective
analysis of existing data, the researches had to perform extensive
statistical adjustments to account for study participants differences.
Even with all these differences taken into account, there was still
a significant improvement in the overall survival of those men who
received active treatment. “This benefit was also seen across
the board in all subgroups examined, including African-American
men and older men aged 75-80 at diagnosis,” added Armstrong.
“However, as we summarized in the study, because observational
data can never completely adjust for potential selection bias and
confounding, our results must be validated by rigorous randomized
controlled trials of elderly men with localized prostate cancer
before the findings can be used to influence treatment decisions.”
This study was funded by the Center for Population Health and Health
Disparities at the University of Pennsylvania, Public Health Services
PENN Medicine is a $2.9 billion enterprise
dedicated to the related missions of medical education, biomedical
research, and high-quality patient care. PENN Medicine consists
of the University of Pennsylvania School of Medicine (founded in
1765 as the nation's first medical school) and the University of
Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt
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the School of Medicine is recognized worldwide for its superior
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and leaders of academic medicine.
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