“I had to worry about prostate cancer only when I was young.”
1. Not true. Most of the deaths from locally advanced prostate cancer occur in men 75 years or older.
“If I have prostate cancer when I’m old, I only need a hormone shot if anything.”
2. Again, not true. In the past several years, two landmark clinical trials have clearly shown there is better survival for men with locally advanced prostate cancer if radiation is added to hormonal therapy versus hormonal therapy alone. These trials have become the “Gold Standard for cancer care.” The effects of radiation therapy were huge-a 50% decrease in prostate cancer deaths.
“Aren’t radiation and hormones only for men in those fancy clinical trials at big centers?”
3. Dr. Justin Bekelman of the University of Pennsylvania School of Medicine recently completed a study of over 31,000 Medicare seniors that led him to conclude that “Men with aggressive prostate cancer regardless of age – where they are in their 50s, 60s, 70s, or 80s – should know that radiation with hormone therapy save lives.” (HemOnctoday: 2015, March, p 24).
“Do I really need to see a radiation specialist too? Can’t my urologist just do everything.”
4. I wish it were that simple. In Bekelman’s study, 49% of men older than 65 years and 61% of men older than 75 years had hormone therapy only, and not radiation plus hormone therapy. That means 1 of 2 men older than 65 years and 3 of 5 men older than 75 years, are not getting the correct therapy.
Dr. Dean Shumway and Dr. Daniel Hamstra, both from the University of Michigan Radiation Oncology Department, commented on Dr.Bekelman’s study and wrote “it is also critical to note that the use of primary androgen deprivation therapy has been found to be highly related to which practitioner a patient sees rather than to the patient or tumor characteristics.” In short, many urologists continue to just prescribe hormone therapy and not radiation, despite the overwhelming evidence for radiation and hormonal therapy.
For more information or to get advice on a specific patient case, feel free to call me, Edward Hughes, M.D., PhD at 855-Dayton1.