Jean-Pierre Droz1, Gilles Albrand2, Silke Gillessen3, Simon Hughes4, Nicolas Mottet5, Stéphane Oudard6, Heather Payne7, Martine Puts8, Gilbert Zulian9, Lodovico Balducci10, Matti Aapro11. 1. Cancer-Environment Research Unit, Centre Léon-Bérard and Claude-Bernard Lyon 1 University, Lyon, France. Electronic address: jpdroz@orange.fr. 2. Groupement Hospitalier Sud des Hospices Civils de Lyon, Hôpital Antoine Charial, Francheville, France. 3. Department of Oncology/Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 4. Oncology Management Offices, Guy's Hospital, London, UK. 5. Department of Urology, Saint-Etienne University Hospital, Saint-Priest en Jarez, France. 6. Oncology Department, Georges Pompidou Hospital, René-Descartes Faculty, Paris 5 University, Paris, France. 7. Department of Oncology, University College London Hospitals, London, UK. 8. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. 9. Hôpital de Bellerive, Geneva University Hospitals, Geneva, Switzerland. 10. H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, FL, USA. 11. Clinique de Genolier, Genolier, Switzerland.
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.
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 cancerpatients are frail and have other medical problems. Treatment in the individual patient should be based on health status and patient preference.
Authors: Annika Herlemann; Alexander Buchner; Alexander Kretschmer; Maria Apfelbeck; Christian G Stief; Christian Gratzke; Stefan Tritschler Journal: World J Urol Date: 2017-05-10 Impact factor: 4.226
Authors: Marie-Rose B S Crombag; Thomas P C Dorlo; Ellen van der Pan; Anoek van Straten; Andries M Bergman; Nielka P van Erp; Jos H Beijnen; Alwin D R Huitema Journal: Pharm Res Date: 2019-11-15 Impact factor: 4.200