Elderly men are more likely to be diagnosed with aggressive cancer, but are often inappropriately denied curative treatment.
Biological rather than chronological age should be used to decide if a patient will profit from radical treatment. Therefore, every man above 70 should undergo a health assessment using a validated tool prior to making treatment decisions. Fit elderly males with intermediate or high-risk disease should be offered standard curative local treatment in keeping with guidelines for younger men. Vulnerable and frail elderly men warrant geriatric intervention prior to treatment. In the case of vulnerable patients, this intervention may render them suitable for standard care. When considering radical prostatectomy outcomes a 'bifecta' of oncological control and continence is appropriate as erectile dysfunction (although prevalent) has a much smaller impact on quality of life than in younger patients. Radiotherapy is an alternative to radical prostatectomy in men with a life expectancy of less than ten years. Primary ADT is not associated with improved survival in localised prostate cancer and should only be used for symptom palliation. Further elderly-specific research is needed to guide prostate cancer care.
Everaerts W, Van Rij S, Reeves F, Costello A. Are you the author?
Royal Melbourne Hospital, Department of Urology and Surgery, Grattan Street, Parkville, VIC, 3050, Australia; Peter MacCallum Cancer centre, Department of surgery, 2 St Andrews Pl, East Melbourne, VIC, 3002, Australia.
Reference: BJU Int. 2015 Mar 23. Epub ahead of print.