Title: International society of geriatric oncology (SIOG) proposal of guidelines for advanced prostate cancer in senior adults
Authors: Droz, J.P.
Balducci, L.
Bolla, M.
Emberton, M.
Fitzpatrick, J.
Joniau, Steven
Kattan, M.
Monfardini, S.
Moul, J.
Naeim, A.
Van Poppel, Hendrik
Saad, F.
Sternberg, C.N. #
Issue Date: Mar-2008
Publisher: Elsevier Science
Host Document: European urology supplements vol:7 issue:3 pages:232-232
Conference: EAU location:Milan, Italy date:26-29 March 2008
Article number: 644
Abstract: Introduction & Objectives: The incidence of prostate cancer increases with age. With the increasing life expectancy in developed countries, many older men are expected to develop advanced prostate cancer. There is currently no guideline for the management of advanced prostate cancer in senior adults (>70 years). The SIOG has developed a proposal for recommendations in this setting.
Material & Methods: A systematic literature search on treatment options for metastatic prostate cancer in senior adults was done. Specific aspects pertaining to a geriatric population were emphasized and included: evaluation of health status and screening for vulnerability and frailty. Particular attention was given to the consequences of androgen deprivation (i.e. osteoporosis). The bibliographic material was reviewed and discussed by a scientific parnel including urologists, radiation oncologists, medical oncologists and geriatricians from both Europe and North America.
Results: Internationally accepted guidelines (NCCN, EAU ...) are valid as well as national scientifically established guidelines. Comorbidity is a key predictor of life expectancy. Hormonal therapy is the first-line treatment in hormone-sensitive metastatic prostate cancer. Nevertheless, benefits and harms should be carefully weighted in senior adults due to the increased risk of metabolic syndrome, cardiovascular mortality and bone fractures. Evaluation of mineral bone status and prevention of osteoporosis are recommended.
In hormone refractory prostate cancer, chemotherapy with docetaxel (75 mg/m2 every 3 weeks-q3w) shows the same efficacy in healthy senior adults as in younger patients. The tolerability of docetaxel q3w has not been specifically studied in vulnerable and frail senior adults. The place of weekly docetaxel in this setting should be further evaluated. Palliative treatments include palliative surgery, radio pharmaceutics, radiotherapy, medical treatments for pain and symptoms. Treatment decisions should be adapted to health status evaluation based on Instrumental Activity daily Living (IADL) activities, comorbidity evaluation by Cumulative Illness Rating Scale-Geriatrics (CISR-G), screening for dementia and malnutrition. Patients in group 1 (healthy senior adults) are likely to receive the same treatment (including standard chemotherapy)as younger patients, patients in group 2 (≥1 impairment in IADL, one non-controlled comorbidity) should receive standard treatment after geriatric intervention, patients in group 3 (major IADL or cognitive impairment, several non-controlled comorbidities, malnutrition) should receive adapted treatment after
medical intervention, patients in group 4 (terminal illness) should receive only symptomatic treatment.
Conclusions: Treatment decisions for advanced prostate cancer should be adapted to health status. Specific prospective studies in senior adults with metastatic prostate cancer are warranted.
ISSN: 1569-9056
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Urology Section (-)
# (joint) last author

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