Management of localized prostate cancer in senior adults: the crucial role of comorbidity.

Prostate cancer is predominantly a disease of senior adults, i.e. those aged >70 years. With the increasing life expectancy worldwide, the burden of prostate cancer in senior adults is expected to increase. The management of senior adults with localized prostate cancer is not optimal. While most senior adults have indolent disease and will not die from it, some patients with aggressive tumours will rapidly progress to an advanced stage if not adequately treated. Treatment decisions need to balance life expectancy and the benefits of therapy vs treatment-related adverse events. Comorbidity is a crucial predictor of nonprostate cancer mortality in senior adults. Moreover, complications of curative treatments appear to be related to comorbidity to a greater degree than to chronological age. Nevertheless, there is evidence that, in everyday clinical practice, treatment decisions are strongly influenced by patient age and that a minority of senior adults with prostate cancer will benefit from curative therapy, regardless of the comorbidity. Conversely, a large proportion of senior adults will receive hormone-deprivation therapy, although it has no curative intent and is associated with an increased risk of metabolic syndrome, cardiovascular mortality and bone fractures. In conclusion, every effort should be made to improve the standard of care of senior adults with localized prostate cancer. There is a need for specific treatment guidelines dedicated to this population.