Prostate Cancer Guidelines Proposals In Senior Adult Men

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Seniors / Aging
Article Date: 23 Sep 2007 - 0:00 PDT

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UroToday.com - Presented Wednesday, 05 September 2007 at the 29th Congress of the Societe International d'Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Prostate cancer incidence increases with age, with a median age at diagnosis of 68 years. Due to the increased life expectancy, prostate cancer has become a major problem of public health. Management of prostate cancer in senior adult men represents a major challenge for the future. No specific guideline has previously been published on the management of prostate cancer in older men (>70 years). The SIOG (International Society of Geriatric Oncology) has developed a proposal of recommendations in this setting.

Methods: A systematic bibliographical search focused on screening, diagnostic procedures, and treatment options for localized, locally advanced prostate cancer and metastatic disease in senior adults has been done. Specific aspects of the geriatric approach were emphasized, as evaluation of health status (nutritional, cognitive, thymic, physical and psycho-social evaluations) and screening for vulnerability and frailty. Attention was drawn on consequences of androgen deprivation and complications of local treatment, mainly incontinence. The collected material has been reviewed and discussed by a scientific panel including urologists, radiation oncologists, medical oncologists and geriatricians from both Europe and North America.

Results: The consensus has been to use either EAU or NCCN clinical recommendations for prostate cancer treatment. They are adapted to health status evaluation based on Instrumental Activities of Daily Living (IADL) , comorbidities evaluation by Cumulative Illness Rating Scale-Geriatrics (CISR-G), screening of dementia. Patients in group 1 (no abnormality) are likely to receive the same treatment as younger patients, patients in group 2 (one impairement in IADL, one non controlled comorbidity) will receive standard treatment after medical intervention, patients in group 3 (major IADL or cognitive impairment, several non controlled comorbidities) will receive adapted treatment, patients in group 4 (dependent) will receive only symptomatic palliative treatment.

Conclusions: Management of prostate cancer in senior adult men should be adapted to health status. Specific prospective studies in senior adults men with prostate cancer are warranted.

Authors: JP Droz, L Balducci, M Bolla, M Emberton, J Fitzpatrick, S Joniau, M Kattan, S Monfardini, J Moul, A Naeim, H van Poppe, F Saad, C Sternberg

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