Surgery for prostate cancer can be safe and worthwhile for older men above the traditional cutoff age of 70. That's the conclusion of emerging research that calls into question the traditional view that men should be denied the surgery based on advanced age alone.
Dr. Shabbir M.H. Alibhai, a scientist at University Health Network and the Toronto Rehabilitation Institute in Canada, published a study evaluating the effect of radical prostatectomyremoval of the prostate gland-among more than 11,000 men in Ontario.
The finding: In otherwise healthy older men up to age 79, the risk of death after this surgery is relatively low.
Rethinking Old Guidelines
Alibhai thinks the study, because it was carefully done and included a large sample size, is beginning to change medical practice.
"We are finding surgeons are less cautious in thinking about this surgery for men over age 70," said Alibhai. "People are being a little bit more scientific about this thing, Isaying, 'Let's look at the aggressiveness of the cancer and how healthy the man is."
The prostate gland, about the size of a walnut and located just below the bladder and in front of the rectum, helps produce seminal fluid. More than 234,000 men in the United States will learn they have prostate cancer this year, and more than 27,000 will die from the disease. Annual exams should begin at age 50—or earlier for men at high risk, according to the American Cancer Society.
Traditionally, Alibhai said, many surgeons would make their decision to remove the prostate based on age alone, suggesting to men over 70 that they undergo radiation or hormone treatment, instead.
Alibhai hopes his research spurs men to act as their own advocate. He believes many men are now justified to say to their surgeon, Just because I am over 70 does not mean I am going to have horrible complications."
For the study, Alibhai and his co-researchers looked at the death and complication rates in 11,010 men who had prostate surgery between 1990 and 1999. The researchers looked at the first 30 days after the procedure.
"Although on a relative level there was an increase in the risk of mortality with each decade of age, the absolute risk was still quite low in older men," Alibhai said.
Overall, 53 men died, and 2,246 had one or more complications within 30 days of surgery. Other factors that increased the risk of 30-day mortality were previous heart disease or stroke, Alibhai said. "If you had either or both those risks, you were at a significantly higher risk of having 30-day mortality than if you didn't have any of those conditions," he said.
The bottom line: The researchers found that what really increases the risk of nearly all complications during the first 30 days after prostate surgery is other medical problems, such as heart problems, rather than age alone.
Alibhai advises men to consider what other health problems they have and how aggressive their cancer is when trying to decide on surgery. "The first thing the person needs to ask is, 'Do I need aggressive therapy? What is the chance this is going to grow and cause me trouble in my remaining days?
"If a man is older than 70, and the cancer isn't that aggressive, he may want to avoid surgery, especially if he has other health problems. But if he's fit and healthy, and the cancer is more aggressive, surgery might be the best choice," Alibhai said.
Men also need to consider the likelihood of long-term complications from surgery, such as urinary incompetence or sexual dysfunction. Such complications weren't studied in Alibhai's research, and the risks do increase with age.
Another expert, Dr. Warren A. Jones, a distinguished professor of health policy and professor of family medicine at the University of Mississippi, said men should discuss the pros and cons of surgery with their family doctor, ideally one they have seen for many years, so he or she can assess their health status and advise them accordingly.