Management of prostate cancer in older patients

Author:

Narita Shintaro12ORCID,Hatakeyama Shingo34ORCID,Sakamoto Shinichi56,Kato Takuma78,Inokuchi Juichi910,Matsui Yoshiyuki1112,Kitamura Hiroshi1314,Nishiyama Hiroyuki1516,Habuchi Tomonori12

Affiliation:

1. Department of Urology , , Akita , Japan

2. Akita University Graduate School of Medicine , , Akita , Japan

3. Department of Urology , , Hirosaki , Japan

4. Hirosaki University Graduate School of Medicine , , Hirosaki , Japan

5. Department of Urology , , Chiba , Japan

6. Chiba University Graduate School of Medicine , , Chiba , Japan

7. Department of Urology , , Kagawa , Japan

8. Kagawa University School of Medicine , , Kagawa , Japan

9. Department of Urology , Graduate School of Medical Sciences, , Fukuoka , Japan

10. Kyushu University , Graduate School of Medical Sciences, , Fukuoka , Japan

11. Department of Urology , , Tokyo , Japan

12. National Cancer Center Hospital , , Tokyo , Japan

13. Department of Urology , , Toyama , Japan

14. University of Toyama Faculty of Medicine , , Toyama , Japan

15. Department of Urology , , Tsukuba , Japan

16. Tsukuba University School of Medicine , , Tsukuba , Japan

Abstract

Abstract The incidence of prostate cancer among older men has increased in many countries, including Asian countries. However, older patients are ineligible for inclusion in large randomized trials, and the existing guidelines for the management of patients with prostate cancer do not provide specific treatment recommendations for older men. Therefore, generation of evidence for older patients with prostate cancer is a key imperative. The International Society of Geriatric Oncology has produced and updated several guidelines for management of prostate cancer in older men since 2010. Regarding localized prostate cancer, both surgery and radiotherapy are considered as feasible treatment options for intermediate- and high-risk prostate cancer even in older men, whereas watchful waiting and active surveillance are useful options for a proportion of these patients. With regard to advanced disease, androgen-receptor axis targets and taxane chemotherapy are standard treatment modalities, although dose modification and prevention of adverse events need to be considered. Management strategy for older patients with prostate cancer should take cognizance of not only the chronological age but also psychological and physical condition, socio-economic status and patient preferences. Geriatric assessment and patient-reported health-related quality of life are important tools for assessing health status of older patients with prostate cancer; however, there is a paucity of evidence of the impact of these tools on the clinical outcomes. Personalized management according to the patient’s health status and tumour characteristics as well as socio-economic condition may be necessary for treatment of older patients with prostate cancer.

Funder

Japan Society for the Promotion of Science

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Radiology, Nuclear Medicine and imaging,Oncology,General Medicine

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