LAS VEGAS--Use of aggressive therapy in elderly prostate cancer
patients has increased despite a lack of clear evidence of benefit,
Michigan investigators reported at the American Urological Association
The researchers found that, in metropolitan Detroit, expenditures
for aggressive therapy in elderly prostate cancer patients rose
750% in one decade, primarily due to increased use of radiotherapy
in these patients.
The conclusions are based on an analysis of data from the Detroit
Cancer Surveillance System, a component of the National Cancer
Institute's Surveillance Epidemiology and End Result (SEER) program.
The data show double-digit increases between 1973 and 1992 in
the use of radical prostatectomy and radiotherapy for localized
disease in men over age 75.
Mirroring national trends, the incidence of prostate cancer increased
substantially in the period covered by the study. The largest
increase in the Detroit area involved men aged 75 to 84, said
James Montie, MD, formerly of Wayne State University, Detroit,
and currently professor of surgery at the University of Michigan.
From 0.6 to 31.5 per 100,000
From 1973 to 1977, the use of radical prostatectomy for localized
disease in men over age 75 averaged 0.6 per 100,000 men over age
75 in the general population (a single procedure during that time
period). By 1992, the rate had increased to 31.5 per 100,000 (51
procedures between 1988 and 1992). Use of radiotherapy in the
elderly prostate cancer population increased even more during
this time frame, from 55 to 605 per 100,000.