(Press-News.org) Increasing percentages of some older U.S. men with intermediate-risk and high-risk prostate cancers are undergoing treatments that carry risks of side effects that can significantly reduce the quality of life without extending life, according to a new study led by Cedars-Sinai. This trend is problematic because these men may not have life expectancies that would allow them to receive the benefits of more aggressive treatments.
The research findings were published in the peer-reviewed journal JAMA Internal Medicine.
Prostate cancer is the second-most common cancer in the U.S., exceeded only by breast cancer. About one-eighth of U.S. men are diagnosed with prostate cancer at a median age of 67 according to the National Cancer Institute. Most patients have slow-growing, localized tumors, confined to the prostate gland, that are unlikely to threaten their lives. Instead of immediate treatment, these low-risk patients can be monitored through “active surveillance,” in which examinations and tests are performed on a regular schedule to make sure the disease is not progressing.
“Use of active surveillance has increased over the last 15 years for men with low-risk prostate cancer, and it is now the most common treatment for these men,” said Timothy Daskivich, MD, director of Urologic Oncology Research for the Cedars-Sinai Department of Urology and corresponding author of the new study. “This approach allows these patients to avoid the risks of urinary incontinence, erectile dysfunction and other potential side effects of surgery and radiation therapy.”
Conservative management, which includes active surveillance or watchful waiting, is also recommended for men with limited life expectancies who likely will not live long enough to benefit from aggressive local treatment, even for higher-risk cancers. However, for these men, the trend is going in the opposite direction, as measured by the investigators’ analysis of extensive data from the Veterans Affairs health system. They found that for men with limited life expectancies and intermediate- and high-risk cancers, conservative management was being employed less often and that more were receiving aggressive local treatment with surgery or radiation.
“We found this pattern surprising,” Daskivich said. “Prostate cancer patients with life expectancies of less than five or 10 years were being subjected to treatments that can take up to a decade to significantly improve their chances of surviving cancer, despite guidelines recommending against treatment.”
For their study, the investigators analyzed medical data on 243,928 men in the Veterans Affairs health system who were diagnosed with localized prostate cancer between 2000 and 2019.
Among patients with average life expectancies of less than 10 years, the proportion who underwent treatments such as surgery or radiation for low-risk prostate cancer rather than receiving active surveillance decreased from 37.4% to 14.7%; but treatment for intermediate-risk disease increased from 37.6% to 59.8%. Among patients with average life expectancies of less than five years, treatment for high-risk disease increased from 17.3% to 46.5%. Among men who were overtreated, roughly 80% were treated with radiation therapy.
Solving the issue of overtreatment in higher-risk prostate cancer patients with limited longevity requires a multifaceted approach involving better estimation, communication, and integration of life expectancy into decision-making, Daskivich said. He and his team have proposed a “trifecta” method for communicating cancer prognosis to the patient. This method involves the physician discussing the likelihood of dying from the cancer with treatment versus without treatment at the endpoint of the patient’s life expectancy. This approach personalizes the risk of the cancer that is relevant to each patient.
“Our goal is to encourage clinicians to make longevity part of the discussion about the best treatment options so that prostate cancer patients with limited life expectancies can make educated choices,” Daskivich said. “A patient may be given this data and choose to pursue surgery or radiation treatments regardless of a limited probability of benefit. Another patient may take a different course.”
“Every individual is different, and statistical averages for lifespan, treatment effectiveness and cancer risk cannot predict outcomes with certainty,” Daskivich added. “But patients should be given the opportunity to make informed decisions with the best possible information.”
Hyung L. Kim, MD, chair of the Department of Urology at Cedars-Sinai, said the JAMA Internal Medicine study reflects a signature strength of Cedars-Sinai: the close cooperation among researchers and clinicians. “Many of our investigators are themselves clinicians, which ensures that their research addresses real-life problems in healthcare with an emphasis on finding solutions,” he said.
Other Cedars-Sinai authors include Michael Luu and John R. Heard. Other authors include I-Chun Thomas from Stanford University and senior author John T. Leppert from Stanford University in Stanford, California, and the VA Palo Alto Health Care System in Palo Alto, California.
This work was supported in part by VA Merit Review (I01 HX0021261 to JL). The Department of Veterans Affairs Health Services Research and Development Service work was supported using resources and facilities at the VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457. The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government.
END
Study: Older adult prostate cancer patients are increasingly being overtreated
Significant percentages of patients who may not live long enough to benefit are undergoing surgeries and radiotherapy, Cedars-Sinai analysis shows
2024-11-11
ELSE PRESS RELEASES FROM THIS DATE:
Experiences of discrimination linked to postpartum weight retention
2024-11-11
PITTSBURGH, November 11, 2024 – Researchers have been unable to explain why after giving birth, Black patients are two to three times as likely to retain or gain additional weight compared to their white counterparts, even when pre-pregnancy weight and gestational-weight trajectories are comparable. A first-of-its-kind study by University of Pittsburgh epidemiologists points to the stress of lived experiences with racism and gender-based discrimination as a possible explanation. The study was reported today in the American Journal of Epidemiology.
Since postpartum weight retention is associated with increased cardiovascular risk and other negative health outcomes that persist ...
New python package, ERTool, developed for efficient multi-source evidence fusion
2024-11-11
Researchers from Peking University have developed ERTool, an open-source Python package designed to simplify the implementation of the Evidential Reasoning (ER) approach for multi-source evidence fusion. This tool addresses the challenges of integrating data from multiple sources in uncertain decision-making environments. The results are published in Health Data Science.
Multi-source evidence fusion plays a critical role in fields such as healthcare management, business analytics, and environmental risk assessment. However, the traditional application of the ER approach has been complicated, requiring expertise in coding. To overcome these challenges, Associate Research Professor Guilan ...
AI-based software 'guide' childbirth by ‘seeing’ the baby’s position in real time
2024-11-11
A new AI-based software has been developed that can be integrated with an ultrasound device to ‘guide’ childbirth by providing precise, real-time information on the baby’s head position. It can clearly indicate to operators—using a traffic light system—whether to proceed with a natural descent in the birth canal, whether to use a vacuum extractor, or even if an emergency cesarean is needed.
This tool, which could be available in delivery rooms starting in 2028, was developed and validated as part of a ...
Arab scholars from around the globe convene in Qatar to advance science and research
2024-11-11
Doha, November 11, 2024 – The Arab Global Scholars (AGS) community gathered at Hamad Bin Khalifa University (HBKU) in Qatar Foundation’s Education City last week to herald the latest evolution of an initiative nurturing a contemporary renaissance of Arab science and research.
An initiative led by Qatar Foundation, AGS aims to reconnect scholars and intellectuals with roots in the Arab world back to their region to contribute to its positive development and long-term future.
Its beginnings going back almost two decades, AGS has solidified itself as an innovation-focused community linking 895 Arab scholars, as well as research ...
Gender inequality ingrained in global climate negotiations, say researchers
2024-11-11
Climate governance is dominated by men, yet the health impacts of the climate crisis often affect women, girls, and gender-diverse people disproportionately, argue researchers ahead of the upcoming 29th United Nations Climate Summit (COP29) in Azerbaijan.
In an article published today in Lancet Planetary Health, a team of researchers – including several from the University of Cambridge – argue that much more needs to be done to mitigate the impacts of climate change on women, girls and gender-diverse individuals.
Focusing specifically on the intersection between climate change, gender, and human health, ...
There's no time like the present for integrating climate and violence policies: The opportunity is right
2024-11-11
The dual goals of climate action and ending violence against children can be achieved according to a new paper by Columbia University Mailman School of Public Health and colleagues at the London School of Hygiene and Tropical Medicine. For the first time, governments are committing funds and making concrete pledges to reach the UN Sustainable Development Goal target of ending violence against children. On November 7th and 8th, the Government of Colombia, with support of the Government of Sweden, UNICEF, the UN Special Representative of the Secretary-General on Violence Against Children, and the World Health Organization will attend the first Global Ministerial Conference on ending ...
Breaking free from negative thoughts using a scientifically gamified app
2024-11-11
(Toronto, November 11, 2024) A new study published in the Journal of Medical Internet Research by JMIR Publications reveals promising results from a digital health intervention that is based on a decade of research at Harvard Medical School and designed to alleviate depressive symptoms. The study, titled "Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial," found that participants experienced substantial reduction of depressive symptoms by using a gamified mobile app focused on disrupting ruminative thinking.
Led by Prof. Moshe Bar and colleagues, the research ...
The emerging role of (p)ppGpp in DNA repair and associated bacterial survival against fluoroquinolones
2024-11-11
Bacteria frequently encounter adverse environmental conditions, such as nutrient scarcity and antibiotic exposure, which can induce DNA damage. Efficient DNA repair mechanisms are essential for bacterial survival, particularly under such stress conditions. A critical player in these processes is the signaling molecule (p)ppGpp, a phosphorylated guanosine synthesized by bacteria during periods of stress. Initially discovered in Escherichia coli under amino acid starvation, (p)ppGpp is now recognized for its broader roles in modulating cellular functions essential for DNA repair and stress response. By regulating diverse cellular processes, (p)ppGpp not ...
People with fewer resources seen as less trustworthy across cultures, new research shows
2024-11-11
New research in Social Psychological and Personality Science identifies a widespread stereotype linking wealth to perceived trustworthiness across diverse cultures. The research, led by Mélusine Boon-Falleur from the Center for Research on Social Inequalities at Sciences Po in Paris, shows that individuals with fewer material resources are consistently viewed as less trustworthy.
The study, conducted across eight countries including Brazil, Colombia, Democratic Republic of Congo, India, France, Nigeria, Philippines, and the United Kingdom, employed a novel method to uncover stereotypes while avoiding social desirability bias.
"People ...
Inland Delaware watersheds impaired by human waste
2024-11-11
Highlights:
Delaware watersheds show high microbial impairment.
Researchers collected samples from Delaware waters over 2 years and identified microbial DNA signatures present in the water.
The findings suggest that both treated and untreated human waste are the culprit, likely due to infrastructural issues.
Washington, D.C.—Delaware has numerous inland waterways with high microbial impairment from unknown sources. Now, a new study suggests that human waste, both treated and untreated, is responsible for the waterway impairment in these Delaware watersheds. The study was published in Applied and Environmental Microbiology, ...
LAST 30 PRESS RELEASES:
Reality check: making indoor smartphone-based augmented reality work
Overthinking what you said? It’s your ‘lizard brain’ talking to newer, advanced parts of your brain
Black men — including transit workers — are targets for aggression on public transportation, study shows
Troubling spike in severe pregnancy-related complications for all ages in Illinois
Alcohol use identified by UTHealth Houston researchers as most common predictor of escalated cannabis vaping among youths in Texas
Need a landing pad for helicopter parenting? Frame tasks as learning
New MUSC Hollings Cancer Center research shows how Golgi stress affects T-cells' tumor-fighting ability
#16to365: New resources for year-round activism to end gender-based violence and strengthen bodily autonomy for all
Earliest fish-trapping facility in Central America discovered in Maya lowlands
São Paulo to host School on Disordered Systems
New insights into sleep uncover key mechanisms related to cognitive function
USC announces strategic collaboration with Autobahn Labs to accelerate drug discovery
Detroit health professionals urge the community to act and address the dangers of antimicrobial resistance
3D-printing advance mitigates three defects simultaneously for failure-free metal parts
Ancient hot water on Mars points to habitable past: Curtin study
In Patagonia, more snow could protect glaciers from melt — but only if we curb greenhouse gas emissions soon
Simplicity is key to understanding and achieving goals
Caste differentiation in ants
Nutrition that aligns with guidelines during pregnancy may be associated with better infant growth outcomes, NIH study finds
New technology points to unexpected uses for snoRNA
Racial and ethnic variation in survival in early-onset colorectal cancer
Disparities by race and urbanicity in online health care facility reviews
Exploring factors affecting workers' acquisition of exercise habits using machine learning approaches
Nano-patterned copper oxide sensor for ultra-low hydrogen detection
Maintaining bridge safer; Digital sensing-based monitoring system
A novel approach for the composition design of high-entropy fluorite oxides with low thermal conductivity
A groundbreaking new approach to treating chronic abdominal pain
ECOG-ACRIN appoints seven researchers to scientific committee leadership positions
New model of neuronal circuit provides insight on eye movement
Cooking up a breakthrough: Penn engineers refine lipid nanoparticles for better mRNA therapies
[Press-News.org] Study: Older adult prostate cancer patients are increasingly being overtreatedSignificant percentages of patients who may not live long enough to benefit are undergoing surgeries and radiotherapy, Cedars-Sinai analysis shows