Systemic therapy of prostate cancer in elderly patients

Background: The vast majority of prostate cancer (PCa) patients are diagnosed beyond the age of 65. However, older, frail patients are often underrepresented in clinical trials of advanced PCa. Materials and methods: This narrative review was prepared based on a literature search of PubMed (MEDLINE) and the American Society of Medical Oncology (ASCO) and European Society for Medical Oncology (ESMO) abstract databases, with a focus on the practical relevance of the data for everyday treatment. Results: Randomized phase III trials in advanced PCa have often showed comparable efficacy of experimental treatments in elderly patients compared to the overall population, although not infrequently at the cost of increased toxicity. Screening tools to assess frailty, such as the G8, may help to better assess the ability of elderly patients to receive systemic therapy. Comorbidities and polypharmacy pose a challenge in everyday treatment and must be considered when choosing therapy. While fit elderly patients should not be denied standard treatment based on their calendrical age alone, frail patients need to be assessed to determine whether targeted geriatric intervention can improve their ability to undergo therapy. In men with severe limitations, treatment must be adjusted accordingly. Conclusion: To date, few studies have specifically targeted elderly and frail PCa patients. Screening tools are rarely used in everyday treatment. A change of mindset is urgently needed here to better serve our patients, especially in the context of a steadily aging population.