Management Of Complications Of Androgen Deprivation Therapy In The Older Man

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 14 Jan 2009 - 7:00 PST

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UroToday.com - Prostate cancer is the most commonly diagnosed cancer and is the second leading cause of cancer-related death amongst men. Due to the high incidence and prevalence in older persons, prostate cancer can be considered an age-associated disease. With the aging of the population, it is expected that the numbers of older men with prostate cancer will rise dramatically. As a result, physicians and their older patients commonly face the dilemma of whether or not to initiate treatment for localized disease or early systemic relapse (i.e., biochemical recurrence).

Although older patients with symptomatic advanced prostate cancer disease benefit from hormonal treatments and chemotherapies, treatment complications may also influence outcome. Older prostate cancer patients have a high prevalence of other factors (such as comorbidity, disability, and geriatric syndromes) that can impact life expectancy and tolerance to treatment. A comprehensive geriatric assessment (CGA) or geriatric screening tools can help identify other health status issues that can predict morbidity or mortality in vulnerable or frail older prostate cancer populations. The CGA has been advocated for detection of disability, comorbidity, and geriatric syndromes for men with prostate cancer.

Many studies have shown that older prostate cancer patients have high levels of impairment on CGA within activities of daily living (ADLs), instrumental activities of daily living (IADLs), comorbidity, physical disability, cognitive disorders, and depressive symptoms. A high proportion of deficits were also noted in a sample of asymptomatic prostate cancer patients aged 70 or over on androgen deprivation therapy. Of major concern is the high prevalence of physical disability in older patients receiving androgen deprivation therapy that places them at higher risk for falling. Screening and evaluation for physical disability is imperative given the high prevalence of osteoporosis and risk for fractures with falling in this vulnerable population. The Vulnerable Elder's Survey demonstrated utility as a screening tool to detect impairments in this sample. This tool could be utilized as a quick screening tool to detect morbidity or mortality risk due to underlying health status in older prostate cancer patients being considered for treatment. In addition, specialists who care for older patients with prostate cancer should work with geriatricians, internists, and others who can provide multidisciplinary comprehensive care to the patient to reduce risk of complications.

Despite a growing body of data, more research is needed to establish optimal treatment strategies for prostate cancer patients diagnosed later in life.

Written by Supriya Mohile, MD as part of Beyond the Abstract on UroToday.com

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