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Illness causes many prostate surgery problems

October 18, 2005

By Anthony J. Brown, MD

NEW YORK (Reuters Health) – Some surgeons are reluctant to
perform surgery to remove the prostate (radical prostatectomy)
on older men with prostate cancer, fearing that with advanced
age the benefits of the procedure are outweighed by the risks.
However, new research suggests that age is not nearly as
important as the presence of other illness in determining
surgical complications.

“Previous studies have shown an increased risk of
short-term complications in older men who undergo radical
prostatectomy,” lead author Dr. Shabbir M. H. Alibhai, from
University Health Network in Toronto, told Reuters Health.
“Until now, nobody really knew how much of this risk was really
a function of age” or the presence of other illnesses.

Taken together with previous reports, “our findings suggest
that appropriately selected older men can experience benefits
from radical prostatectomy” without having a markedly increased
risk of complications, Alibhai said.

The new findings, which appear in the Journal of the
National Cancer Institute, are based on a study of 11,010 men
who underwent radical prostatectomy in Ontario, Canada during
the 1990s.

Fifty-three men died (0.5 percent) and 2246 experienced at
least one complication within 30 days of radical prostatectomy,
the authors report.

Although increasing age was identified as risk factor for
death within the first 30 days, the overall risk of death was
low, even in men between 70 and 79 years of age — 0.66
percent.

Advancing age was tied to an increased risk of heart, lung
and miscellaneous medical complications, but the effect of
other conditions on these events was generally even stronger.

Based on the current findings, many older men are good
candidates for radical prostatectomy, provided they have few
other medical problems, Alibhai noted. By the same token, the
results also suggest that middle-aged men with many other
conditions may be better served by a less aggressive treatment
approach.

SOURCE: Journal of the National Cancer Institute, October
19, 2005.




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