Anthony L. Komaroff, M.D.
Tribune Media Services
October 14, 2010
Harvard Health Letters
Q. I've heard that doctors feel men over 60 shouldn't be treated for prostate cancer because they're old enough that they are going to die anyway. Is that so?
A. Goodness, no. Any doctor will treat a person for cancer if he or she thinks that treatment will extend that person's life and reduce suffering, regardless of that person's age. And many men over age 60 are treated for prostate cancer.
Here's what probably confused you: Most people think of all cancers as really bad actors that grow rapidly, damage the organ that they started in, and spread (metastasize) throughout the body. But some cancers—and prostate cancer is a good example—often don't grow rapidly and spread. In fact, a lot of men die of other causes and are found on autopsy to have small undiagnosed cancers inside their prostate glands that never caused any symptoms. These "indolent" cancers had probably been there for years. The men died with but not from prostate cancer.
At the same time, treatments for prostate cancer—surgery, radiation, chemotherapy—can cause harmful side effects like an inability to control urination (urinary incontinence) and erectile dysfunction. No one wants the treatment to be worse than the disease, and that's much more likely to happen if the potential of harm from a disease is low.
Doctors have ways of estimating whether a newly discovered prostate cancer is more likely to be aggressive or indolent, although the predictions are not as precise as we would like. When a prostate cancer appears to be indolent, doctors sometimes suggest to patients that it be closely monitored for growth or spread, instead of treating it right away. That approach is called watchful waiting, although to make it sound more appealing, some doctors have renamed it active surveillance. Regardless of what you call it, it's often the best course of action.—Anthony L. Komaroff, M.D., Editor in Chief, Harvard Health Letter
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