Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults

• Published in: Critical reviews in oncology/hematology Vol. 73; no. 1; pp. 68 - 91
• Main Authors: Droz, Jean-Pierre, Balducci, Lodovico, Bolla, Michel, Emberton, Mark, Fitzpatrick, John M, Joniau, Steven, Kattan, Michael W, Monfardini, Silvio, Moul, Judd W, Naeim, Arash, van Poppel, Hendrik, Saad, Fred, Sternberg, Cora N
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.01.2010; Elsevier
• Subjects: Aged; Biological and medical sciences; Clinical management; Comorbidity; Disease Progression; Elderly; Guidelines; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Hematology, Oncology and Palliative Medicine; Humans; Localised disease; Male; Male genital diseases; Medical sciences; Metastatic disease; Nephrology. Urinary tract diseases; Practice Guidelines as Topic; Prognosis; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - therapy; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Metastatic disease; Clinical management; Comorbidity; Localised disease; Elderly; Prostate cancer; Guidelines; Human; Urinary system disease; Prostate disease; Malignant tumor; Metastasis; Recommendation; Concomitant disease; Cancerology; Adult; Advanced stage; Male genital diseases; Cancer
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2009.09.005

Abstract Background The incidence of prostate cancer increases with age, with a median age at diagnosis of 68 years. Owing to increased life expectancy, the management of prostate cancer in senior adult men (i.e., aged 70 years or older) represents an important public health concern and a major challenge for the future. No specific guidelines have previously been published on the management of prostate cancer in older men. The SIOG has developed a proposal of recommendations in this setting. Methods A systematic bibliographical search focused on screening, diagnostic procedures, treatment options for localised, locally advanced and metastatic prostate cancer in senior adults was performed. Specific aspects of the geriatric approach were emphasised, including evaluation of health status (nutritional, cognitive, thymic, physical and psycho-social) and screening for vulnerability and frailty. Attention was drawn to the 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 is to use either European Association of Urology or National Comprehensive Cancer Network clinical recommendations for prostate cancer treatment and to adapt them to health status based on instrumental activities of daily living (IADL) and activities daily living (ADL), comorbidity evaluation by Cumulative Illness Scoring Rating-Geriatrics and screening for malnutrition. Patients in Group 1 (no abnormality) are ‘fit’ and should receive the same treatment as younger patients; patients in Group 2 (one impairment in IADL or one uncontrolled comorbidity or at risk of malnutrition) are ‘vulnerable’ and should receive standard treatment after medical intervention; patients in Group 3 (one impairment in ADL or more than one uncontrolled comorbidity or severe malnutrition) are ‘frail’ and should receive adapted treatment; patients in Group 4 (dependent) should receive only symptomatic palliative treatment. Conclusions Treatment of prostate cancer in senior adults should be adapted to health status. Specific prospective studies in this setting are warranted.