Thirty-three elderly men, most with advanced and aggressive forms of prostate cancer, were treated with external beam radiation therapy at the same radiation levels used to treat patients in their 50s and 60s. The elderly patients, whose five-year survival rate was 61.6 percent, experienced no unusual or prolonged interruptions in treatment due to illness from radiation, said study author Melvin Deutsch, M.D., the Raul Mercado professor of radiation oncology at the University of Pittsburgh Medical Center.
Thirteen of the elderly patients were alive and disease-free 23 to 83 months after treatment. Six patients with evidence of cancer progression were alive 44 to 98 months after treatment. Of the fourteen patients who died during the 10-year study, five had no evidence of prostate cancer, four had evidence of disease progression, and five had an unknown status of the disease.
"The 61 percent survival rate is better than the five-year survival rate for lung cancer patients, and lung cancer is aggressively treated with radiation," Dr. Deutsch said. "So why not give elderly patients the benefit of the doubt? There's a good chance they'll live another five years."
Not all elderly cancer patients are good candidates for radiation therapy, such as those who are severely ill or incapacitated, according to Dr. Deutsch. For others, their physicians may pursue alternative treatments, such as hormone therapy or a "watchful waiting" approach. Dr. Deutsch also points out that there is a school of thought that the effort and cost of radiation therapy is not beneficial to patients in their advanced stages of life. But if the decision to treat elderly prostate cancer patients with radiation rests on whether they can endure it, the results from the 33 elderly men in this study show that they can, according to Dr. Deutsch.
"When an 80-year-old patient comes to me with prostate cancer, assuming he's otherwise healthy, I'm going to treat him with radiation," Dr. Deutsch said. "If it can keep the cancer from coming back, then I say do it."
Co-authors of the study were Diane M. Heaton, M.D., and Maury M. Rosenstein, M.D.
RSNA is an association of more than 35,000 radiologists, radiation oncologists and related scientists committed to promoting excellence in radiology through education and by fostering research, with the ultimate goal of improving patient care. The Society is based in Oak Brook, Ill.
Editor's notes: Dr. Deutsch presented data at RSNA 2000 showing that women age 80 and older had a five-year survival rate of 78 percent after they were treated with radiation for breast cancer. The breast irradiation followed lumpectomies. External beam radiation therapy was well tolerated in all 47 patients, and the majority had good to excellent cosmetic results.
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