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Prostate Cancer: Comorbidities, Treatment, & Survival

In 2008, the United States Preventive Services Task Force released recommendations on screening for prostate cancer that indicated men aged 75 or older should not undergo PSA screening. Using that as a proxy, physicians will often not treat men with the disease who fall in this age range. It’s often believed that men won’t realize the benefits of surgery or radiation therapy for prostate cancer until 10 to 15 years after treatment. In addition, few men who reach the age of 75 are expected to reach age 90. New Data on Comorbidities in Prostate Cancer In prostate cancer, age has long been viewed in the context of outcomes, but new research is showing that comorbidities are another important consideration. My colleagues and I had a study published in the Journal of General Internal Medicine in which we sought to determine the 10-year life expectancy of men with prostate cancer who had one or no comorbid conditions. We found that 84% of all men with no comorbid conditions lived at least 10 years. For men aged 75 or older, 58% lived beyond 10 years. Ten-year survival rates were: 65% for those with comorbid diabetes with no associated organ damage. 51% for those with comorbid peripheral vascular disease. 50% for diabetics with organ damage. 35% for men with moderate to severe COPD. These rates were for non-prostate cancer-related survival. Surprisingly, men with some severe comorbid conditions— moderate-to-severe COPD, diabetes with organ damage, congestive heart failure, stroke, heart attack, liver disease, and peripheral vascular disease—were treated at the same rate as men with no comorbidities. It appears that when patients tell physicians...
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