Figure 1 – Life expectancy through the years in various parts of the world:
Figure 2 – Prostate cancer age at diagnosis:
Aging is associated with increased comorbidities, which may affect the tolerance of therapies for prostate cancer. It is also unclear to what extent do trial results apply to older patients, as they are significantly underrepresented in these trials, as can be seen in Table 1. Lastly, it is also important to consider the cognitive impairment and consent issues that are associated with aging, however, age alone should not determine how we treat patients.
Table 1 – Metastatic hormone-sensitive prostate cancer trials and age:
The international society of geriatric oncology (SIOG) has had a series of taskforces since 2010 and have formed guidelines for the assessment of elderly patients. Some of the recommended tools to assess elderly patients include the G8 screening tool, which is composed of 8 components covering food intake, weight loss, body mass index, mobility, neuropsychological problems, polypharmacy, self-perceived health status, and age. Another tool is the Mini-Cog screening tool, which is more practical than the mini-mental state examination. A cutoff point of 3/5 indicates a need to refer the patient for full valuation of potential dementia. These tools should be used in the clinic to assess elderly patients.
In summary, it is important to manage patients according to individual health status. Physicians should use tools to assess older patients:
- If they are fit – they should be treated according to the standard protocol.
- If they are vulnerable – they may have reversible issued that can be corrected.
- If they are frail – The treatment needs to be modified accordingly.
Presented by: Joe M. O’Sullivan, MD, Clinical Director of Oncology at the Cancer Centre at Belfast City Hospital, Northern Ireland Cancer Center, Belfast
Written by: Hanan Goldberg, MD, Urology Department, SUNY Upstate Medical University, Syracuse, New York, USA @GoldbergHanan at the 2019 Advanced Prostate Cancer Consensus Conference (APCCC) #APCCC19, Aug 29 - 31, 2019 in Basel, Switzerland
Further Related Content: The Aging Population: Oncogeriatric Assessment and Treatment Considerations Presentation