Does age matter in selection of treatment for men with early-stage prostate cancer?

For men under the age 55 with localized prostate cancer, external beam radiation may be an effective alternative to both conservative and more invasive treatments, according to a new study.

Published in the June 15, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that external beam radiation therapy is as effective in younger prostate cancer patients as it is in older patients with same stage, localized disease. The study is the first to investigate the outcome of radiation in men under 55 years of age.

Age remains a controversial factor in prostate cancer, with younger age at diagnosis perceived to be associated with more aggressive disease and poorer prognosis. Consequently, physicians tend to recommend more aggressive treatments, such as radical prostatectomy, to younger patients, even those with local, non-metastatic disease. Older patients diagnosed with similar organ-limited disease, however, are offered more choices, including external beam radiation therapy. Recently studies have shown that radiation therapy is effective in treating localized prostate cancer in elderly patients and in men under 65 years of age.

Andre Konski, M.D., M.B.A., M.A, Clinical Research Director, Radiation Oncology Department at the Fox Chase Cancer Center in Philadelphia, and colleagues compared how men 55 and under fared five years after diagnosis compared to men between 60 and 69 and men 70 and over, looking at survival, disease progression, and whether blood tests (PSA) showed signs of disease recurrence. All the men had localized prostate cancer and were treated with external beam radiation.

They found no statistically significant differences in the outcomes of these three age groups after five years: 94 percent, 95 percent and 87 percent of patients in each respective age category were alive five years after diagnosis; 96 percent, 97 percent and 98 percent of patients in each respective age category were without metastatic disease; and 82 percent, 76 percent, and 70 percent of patients in each respective age category had no evidence of disease recurrence according to blood.

While this study did not compare radiation to other therapies, "external beam radiation at appropriate dose levels has been shown to be equivalent to permanent prostate seed implant and radical prostatectomy in the treatment of patients with stage T1-2 prostate cancer," say the authors. Because younger men with localized disease respond as well as older men to radiation, the authors suggest that this less invasive treatment option should be considered for this patient population.

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