PROSTATE CANCER IS NOT THE MAIN CAUSE OF DEATH

Other Health Issues May Be Neglected in Men With Prostate Cancer

NEW YORK (Reuters Health) Jan 27 - The majority of men with early-stage low/moderate-grade prostate cancer die from causes other than prostate cancer, researchers report in the January issue of the Journal of the American Geriatric Society. Therefore, they say, prevention and management of comorbid health conditions is important.

"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 existing comorbidities may substantially affect their overall survival," they point out.

Dr. 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 outcomes in 208,601 men between the ages of 65 and 84 years diagnosed with prostate cancer from 1988 through 2002. Overall, 59.1% of the entire cohort had early-stage prostate cancer with low- to moderate-grade tumors.

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

"The substantial effect of comorbid conditions on survival and the high rate of mortality related to non-prostate cancer have important implications," Dr. Goodwin's team writes.

"First, as others have suggested, decisions about management of localized prostate cancer should incorporate not only life expectancy based on age, but also the important contributions of specific comorbid conditions," they note. "Second, the choice to use androgen deprivation therapy, now a common treatment even for early-stage prostate cancer, should be made carefully in the presence of significant comorbidity."

Overall, the team concludes, 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."