Management of Prostate Cancer in Elderly Patients: Recommendations of a Task Force of the International Society of Geriatric Oncology

被引:146
作者
Droz, Jean-Pierre [1 ,2 ]
Albrand, Gilles [3 ]
Gillessen, Silke [4 ]
Hughes, Simon [5 ]
Mottet, Nicolas [6 ]
Oudard, Stephane [7 ]
Payne, Heather [8 ]
Puts, Martine [9 ]
Zulian, Gilbert [10 ]
Balducci, Lodovico [11 ]
Aapro, Matti [12 ]
机构
[1] Ctr Leon Berard, Canc Environm Res Unit, Lyon, France
[2] Claude Bernard Lyon 1 Univ, Lyon, France
[3] Hop Antoine Charial, Grp Hosp Sud Hosp Civils Lyon, Francheville, France
[4] Cantonal Hosp St Gallen, Dept Oncol Hematol, St Gallen, Switzerland
[5] Guys Hosp, Oncol Management Off, London, England
[6] St Etienne Univ Hosp, Dept Urol, St Priest En Jarez, France
[7] Paris 5 Univ, Dept Oncol, Georges Pompidou Hosp, Rene Descartes Fac, Paris, France
[8] Univ Coll London Hosp, Dept Oncol, London, England
[9] Univ Toronto, Lawrence S Bloomberg Fac Nursing, Toronto, ON, Canada
[10] Geneva Univ Hosp, Hop Bellerive, Geneva, Switzerland
[11] Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL USA
[12] Clin Genolier, Genolier, Switzerland
关键词
Prostate cancer; Geriatric assessment; Health evaluation; Comorbidities; Elderly; Guidelines; ANDROGEN-DEPRIVATION THERAPY; ESTRO-SIOG GUIDELINES; RADICAL PROSTATECTOMY; RADIATION-THERAPY; DECISION-MAKING; OLDER; ENZALUTAMIDE; RADIOTHERAPY; DOCETAXEL; RISK;
D O I
10.1016/j.eururo.2016.12.025
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
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. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:521 / 531
页数:11
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