Ageism in the Undertreatment of High-Risk Prostate Cancer: How Long Will Clinical Practice Patterns Resist the Weight of Evidence?
Mené sur 3 cohortes incluant au total 31 541 patients atteints d'un cancer de la prostate de stade localement avancé diagnostiqué entre 1995 et 2007 (âge : de 65 à 85 ans ; durée de suivi : jusqu'en 2009), cet essai évalue l'intérêt d'ajouter une radiothérapie à un traitement anti-androgénique pour réduire la mortalité spécifique et la mortalité toutes causes confondues
Age discrimination is defined as “the denial of privilege or other unfair treatment based on the age of the person who is discriminated against, and is a topic that has been studied at length in the field of oncology. For instance, despite obtaining similar survival benefit as younger patients, elderly patients are less likely to receive either surgery or radiation therapy (RT) for oropharyngeal squamous cell carcinoma. With rectal cancer, patients older than age 65 are less likely to receive preoperative radiotherapy, which has been demonstrated to reduce local recurrence rates and is widely considered as the standard of care for intermediate and locally advanced disease. Alarmingly, age-based discrimination is especially prevalent in men with high-risk prostate cancer; some have noted that for men older than 75 years of age with high-risk prostate cancer, 67% received primary androgen-deprivation therapy (ADT) or no therapy at all, and only 33% received any local therapy. With recent guidelines recommending against prostate-specific antigen screening and increased attention given to the role of active surveillance for low-risk prostate cancer, it is easy to lose sight of the fact that prostate cancer is a leading cause of cancer mortality in men, second only to lung cancer. Ultimately, the majority of men diagnosed with locally advanced or high-risk prostate cancer will succumb to their disease within 15 years with conservative treatment, regardless of their age at diagnosis. Y et numerous studies have demonstrated widespread undertreatment of high-risk prostate cancer in older men, despite the observation that older men are more likely to have high-risk disease and account for approximately half of deaths as a result of prostate cancer.Furthermore, undertreatment of high-risk prostate cancer is a growing problem, with an increasing use of primary ADT monotherapy over time. Given that an average 75-year-old man in the United States has a remaining life expectancy of 11 years, and that the 10-year cause-specific mortality from conservatively treated high-risk prostate cancer is approximately 26%, this represents a serious potential for age-dependent bias against therapy...
Journal of Clinical Oncology , éditorial en libre accès, 2015