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Platinum Priority – Review – Prostate Cancer
Editorial by XXX on pp. x–y of this issue

Management of Prostate Cancer in Elderly Patients: Recommendations of a Task Force of the International Society of Geriatric Oncology

By: Jean-Pierre Droza , Gilles Albrandb, Silke Gillessenc, Simon Hughesd, Nicolas Mottete, Stéphane Oudardf, Heather Payneg, Martine Putsh, Gilbert Zuliani, Lodovico Balduccij and Matti Aaprok

European Urology, January 2017

Published online: 12 January 2017

Keywords: Prostate cancer, Geriatric assessment, Health evaluation, Comorbidities, Elderly, Guidelines

Abstract Full Text Full Text PDF (444 KB)

Abstract

Context

Prostate cancer is the most frequent male cancer. Since the median age of diagnosis is 66 yr, many patients require both geriatric and urologic evaluation if treatment is to be tailored to individual circumstances including comorbidities and frailty.

Objective

To update the 2014 International Society of Geriatric Oncology (SIOG) guidelines on prostate cancer in men aged >70 yr. The update includes new material on health status evaluation and the treatment of localised, advanced, and castrate-resistant disease.

Data acquisition

A multidisciplinary SIOG task force reviewed pertinent articles published during 2013–2016 using search terms relevant to prostate cancer, the elderly, geriatric evaluation, local treatments, and castration-refractory/resistant disease. Each member of the group proposed modifications to the previous guidelines. These were collated and circulated. The final manuscript reflects the expert consensus.

Data synthesis

Elderly patients should be managed according to their individual health status and not according to age. Fit elderly patients should receive the same treatment as younger patients on the basis of international recommendations. At the initial evaluation, screening for cognitive impairment is mandatory to establish patient competence in making decisions. Initial evaluation of health status should use the validated G8 screening tool. Abnormal scores on the G8 should lead to a simplified geriatric assessment that evaluates comorbid conditions (using the Cumulative Illness Score Rating-Geriatrics scale), dependence (Activities of Daily Living) and nutritional status (via estimation of weight loss). When patients are frail or disabled or have severe comorbidities, a comprehensive geriatric assessment is needed. This may suggest additional geriatric interventions.

Conclusions

Advances in geriatric evaluation and treatments for localised and advanced disease are contributing to more appropriate management of elderly patients with prostate cancer. A better understanding of the role of active surveillance for less aggressive disease is also contributing to the individualisation of care.

Patient summary

Many men with prostate cancer are elderly. In the physically fit, treatment should be the same as in younger patients. However, some elderly prostate cancer patients are frail and have other medical problems. Treatment in the individual patient should be based on health status and patient preference.

Take Home Message

Advances in geriatric evaluation and treatments for localised and advanced disease are contributing to more appropriate management of elderly patients with prostate cancer. A better understanding of the role of active surveillance for less aggressive disease is also contributing to the individualisation of care.

Keywords: Prostate cancer, Geriatric assessment, Health evaluation, Comorbidities, Elderly, Guidelines.

Footnotes

a Cancer–Environment Research Unit, Centre Léon-Bérard and Claude-Bernard Lyon 1 University, Lyon, France

b Groupement Hospitalier Sud des Hospices Civils de Lyon, Hôpital Antoine Charial, Francheville, France

c Department of Oncology/Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

d Oncology Management Offices, Guy's Hospital, London, UK

e Department of Urology, Saint-Etienne University Hospital, Saint-Priest en Jarez, France

f Oncology Department, Georges Pompidou Hospital, René-Descartes Faculty, Paris 5 University, Paris, France

g Department of Oncology, University College London Hospitals, London, UK

h Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

i Hôpital de Bellerive, Geneva University Hospitals, Geneva, Switzerland

j H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, FL, USA

k Clinique de Genolier, Genolier, Switzerland

Corresponding author. Cancer–Environment Research Unit, Centre Léon-Bérard and Claude-Bernard Lyon 1 University, 24 Allée de Verdun, 69500 Bron, France. Tel. +33 643 178411.

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