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

被引:81
作者
Droz, Jean-Pierre [1 ,2 ]
Balducci, Lodovico [3 ]
Bolla, Michel [4 ]
Emberton, Mark [5 ]
Fitzpatrick, John M. [6 ,7 ]
Joniau, Steven [8 ]
Kattan, Michael W. [9 ]
Monfardini, Silvio [10 ]
Moul, Judd W. [11 ]
Naeim, Arash [12 ]
van Poppel, Hendrik [8 ]
Saad, Fred [13 ]
Sternberg, Cora N. [14 ]
机构
[1] Ctr Leon Berard, Dept Med Oncol, F-69008 Lyon, France
[2] Univ Lyon 1, F-69365 Lyon, France
[3] Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL 33612 USA
[4] Albert Michallon Hosp, Dept Radiat Therapy, Grenoble, France
[5] UCL, Inst Urol & Nephrol, London WC1E 6BT, England
[6] Mater Misericordiae Univ Hosp, Dublin, Ireland
[7] Univ Coll Dublin, Dublin 2, Ireland
[8] Katholieke Univ Leuven Hosp, Dept Urol, Leuven, Belgium
[9] Case Western Reserve Univ, Cleveland Clin, Lerner Coll Med, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA
[10] Ist Palazzolo, Ist Oncol, Geriatr Oncol Program, Milan, Italy
[11] Duke Univ, Med Ctr, Div Urol Surg, Durham, NC USA
[12] Univ Calif Los Angeles, David Geffen Sch Med, Div Hematol Oncol & Geriatr, Los Angeles, CA 90095 USA
[13] Univ Montreal, Notre Dame Hosp, Ctr Hosp, Urooncol Clin, Montreal, PQ H3C 3J7, Canada
[14] San Camillo Forlanini Hosp, Dept Med Oncol, Rome, Italy
关键词
Clinical management; Elderly; Guidelines; Localised disease; Metastatic disease; Prostate cancer; Comorbidity; ANDROGEN DEPRIVATION THERAPY; COMPREHENSIVE GERIATRIC ASSESSMENT; QUALITY-OF-LIFE; RADICAL RETROPUBIC PROSTATECTOMY; MITOXANTRONE PLUS PREDNISONE; INTENSITY FOCUSED ULTRASOUND; CONFORMAL RADIATION-THERAPY; PHASE-III TRIAL; ELDERLY-PATIENTS; OLDER MEN;
D O I
10.1016/j.critrevonc.2009.09.005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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 I (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. (C) 2009 Published by Elsevier Ireland Ltd.
引用
收藏
页码:68 / 91
页数:24
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