Abstract
In patients diagnosed with prostate cancer, the selection of treatment, including the type of therapy and its aggressiveness, is often based on a patient's age and life expectancy. Life expectancy estimates are too often calculated solely on the patient's chronological age, overlooking comorbid conditions and their severity, which can greatly affect life expectancy. If, in addition to chronological age, comorbid conditions are used to assess a patient's life expectancy, the most appropriate treatment options are more likely to be selected. Older, healthy patients might be able to tolerate more aggressive treatment than would be administered on the basis of their age alone, and younger patients with numerous comorbid conditions could avoid harsh therapy that might not be appropriate given their current state of health. The key idea to consider in treatment selection is what a patient's quality of life would be like with or without a particular treatment option. In an era of precision medicine, decisions regarding the provision of health care should be made rationally and on the basis of objective estimates of the threat of disease and the benefits and costs of intervention and within the context of the patient's characteristics and desires.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Global Burden of Disease Cancer Collaboration. The global burden of cancer 2013. JAMA Oncol. 1, 505–527 (2015).
Surveillance, Epidemiology, and End Results Program. SEER stat fact sheets: prostate cancer. National Cancer Institute [online], (2015).
Ortman, J., Velkoff, V. & Hogan, H. An Aging Nation: The Older Population in the United States. United States Census Bureau [online], (2014).
Hobbs, F. & Stoops, N. Demographic trends in the 20th century. United States Census Bureau [online], (2002).
American Cancer Society. Cancer treatment and survivorship facts and figures 2014–2015. [online], (2014).
de Camargo Cancela, M., Comber, H. & Sharp, L. Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: a population-based study. Br. J. Cancer 109, 272–279 (2013).
Scosyrev, E., Messing, E. M., Mohile, S., Golijanin, D. & Wu, G. Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality. Cancer 118, 3062–3070 (2012).
Richstone, L. et al. Radical prostatectomy in men aged ≥70 years: effect of age on upgrading, upstaging, and the accuracy of a preoperative nomogram. BJU Int. 101, 541–546 (2008).
Shah, N., Ioffe, V. & Kapur, A. A comparative analysis of prostate cancer pre-treatment characteristics stratified by age. Can. J. Urol. 21, 7213–7216 (2014).
Carter, H. B. et al. Early detection of prostate cancer: AUA guideline. J. Urol. 190, 419–426 (2013).
Davis, J. W. et al. Disease reclassification risk with stringent criteria and frequent monitoring in men with favourable-risk prostate cancer undergoing active surveillance. BJU Int. http://dx.doi.org/10.1111/bju.13193 (2015).
Daskivich, T. J. et al. Prediction of long-term other-cause mortality in men with early-stage prostate cancer: results from the Prostate Cancer Outcomes Study. Urology 85, 92–100 (2015).
Bechis, S. K., Carroll, P. R. & Cooperberg, M. R. Impact of age at diagnosis on prostate cancer treatment and survival. J. Clin. Oncol. 29, 235–241 (2011).
[No authors listed.] Life expectancy. Merriam-Webster [online].
Kim, H. L., Puymon, M. R., Qin, M., Guru, K. & Mohler, J. L. A method for using life tables to estimate lifetime risk for prostate cancer death. J. Natl Compr. Canc. Netw. 8, 148–154 (2010).
Memorial Sloan Kettering Cancer Center. Prostate cancer. [online], (2015).
Social Security Administration. Retirement and survivors benefits: life expectancy calculator. [online].
Puts, M. T. et al. Use of geriatric assessment for older adults in the oncology setting: a systematic review. J. Natl Cancer Inst. 104, 1133–1163 (2012).
Terret, C., Albrand, G. & Droz, J. P. Geriatric assessment in elderly patients with prostate cancer. Clin. Prostate Cancer 2, 236–240 (2004).
Sammon, J. D. et al. Predicting life expectancy in men diagnosed with prostate cancer. Eur. Urol. 6, 756–765 (2015).
Charlson, M. E., Pompei, P., Ales, K. L. & MacKenzie, C. R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis. 40, 373–383 (1987).
Cowen, M. E., Halasyamani, L. K. & Kattan, M. W. Predicting life expectancy in men with clinically localized prostate cancer. J. Urol. 175, 99–103 (2006).
Daskivich, T. J. et al. Effect of age, tumor risk, and comorbidity on competing risks for survival in a U.S. population-based cohort of men with prostate cancer. Ann. Intern. Med. 158, 709–717 (2013).
Esserman, L. J., Thompson, I. M. Jr. & Reid, B. Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA 310, 797–798 (2013).
Daskivich, T. J. The importance of accurate life expectancy prediction in men with prostate cancer. Eur. Urol. 68, 766–767 (2015).
Jameson, J. L. & Longo, D. L. Precision medicine — personalized, problematic, and promising. N. Engl. J. Med. 372, 2229–2234 (2015).
Collins, F. S. & Varmus, H. A new initiative on precision medicine. N. Engl. J. Med. 372, 793–795 (2015).
Leyten, G. H. et al. Prospective multicentre evaluation of PCA3 and TMPRSS2-ERG gene fusions as diagnostic and prognostic urinary biomarkers for prostate cancer. Eur. Urol. 65, 534–542 (2014).
Antonarakis, E. S. et al. AR-V7 and resistance to enzalutamide and abiraterone in prostate cancer. N. Engl. J. Med. 371, 1028–1038 (2014).
Naqvi, K. et al. Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model. J. Clin. Oncol. 29, 2240–2246 (2011).
Fried, V., Bernstein, A. & Bush, M. Multiple chronic conditions among adults aged 45 and over: trends over the past 10 years. Centers for Disease Control and Prevention [online], (2012).
Fouad, M. N. et al. Comorbidity independently predicted death in older prostate cancer patients, more of whom died with than from their disease. J. Clin. Epidemiol. 57, 721–729 (2004).
Kramer, B. S. The science of early detection. Urol. Oncol. 22, 344–347 (2004).
Walz, J. et al. A nomogram predicting 10-year life expectancy in candidates for radical prostatectomy or radiotherapy for prostate cancer. J. Clin. Oncol. 25, 3576–3581 (2007).
Levine, G. N. et al. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society and American Urological Association: endorsed by the American Society for Radiation Oncology. Circulation 121, 833–840 (2010).
Nguyen, P. L. et al. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur. Urol. 67, 825–836 (2015).
Gandaglia, G. et al. Cardiovascular mortality in patients with metastatic prostate cancer exposed to androgen deprivation therapy: a population-based study. Clin. Genitourin. Cancer 13, e123–e130 (2015).
Nguyen, P. L. et al. Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. JAMA 306, 2359–2366 (2011).
Langley, R. E. et al. Cardiovascular outcomes in patients with locally advanced and metastatic prostate cancer treated with luteinising-hormone-releasing-hormone agonists or transdermal oestrogen: the randomised, phase 2 MRC PATCH trial (PR09). Lancet Oncol. 14, 306–316 (2013).
Kopp, R. P. et al. The burden of urinary incontinence and urinary bother among elderly prostate cancer survivors. Eur. Urol. 64, 672–679 (2013).
Anderson, J. et al. Chemotherapy for older patients with prostate cancer. BJU Int. 99, 269–273 (2007).
Shariat, S. F., Karakiewicz, P. I., Roehrborn, C. G. & Kattan, M. W. An updated catalog of prostate cancer predictive tools. Cancer 113, 3075–3099 (2008).
Ganz, P. A. Institute of Medicine report on delivery of high-quality cancer care. J. Oncol. Pract. 10, 193–195 (2014).
Kent, M. & Vickers, A. J. A systematic literature review of life expectancy prediction tools for patients with localized prostate cancer. J. Urol. 193, 1938–1942 (2015).
Tewari, A. et al. Long-term survival probability in men with clinically localized prostate cancer: a case-control, propensity modeling study stratified by race, age, treatment and comorbidities. J. Urol. 171, 1513–1519 (2004).
Mariotto, A. B., Yabroff, K. R., Shao, Y., Feuer, E. J. & Brown, M. L. Projections of the cost of cancer care in the United States: 2010–2020. J. Natl Cancer Inst. 103, 117–128 (2011).
Ording, A. G. et al. Does comorbidity interact with prostate cancer to increase mortality? A Danish cohort study of 45 326 prostate cancer patients diagnosed during 1995–2011. Acta Oncol. http://dx.doi.org/10.3109/0284186X.2015.1105382 (2015).
Clarke, M. G., Kennedy, K. P. & MacDonagh, R. P. Development of a clinical prediction model to calculate patient life expectancy: the measure of actuarial life expectancy (MALE). Med. Decis. Making 29, 239–246 (2009).
Kaplan, M. H. & Feinstein, A. R. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J. Chronic Dis. 27, 387–404 (1974).
Stier, D. M. et al. Quantifying comorbidity in a disease-specific cohort: adaptation of the Total Illness Burden Index to prostate cancer. Urology 54, 424–429 (1999).
Albertsen, P. et al. Impact of comorbidity on survival among men with localized prostate cancer. J. Clin. Oncol. 29, 1335–1341 (2011).
Guzzo, T. J. et al. Prediction of mortality after radical prostatectomy by Charlson Comorbidity Index. Urology 76, 553–557 (2010).
Froehner, M. et al. A combined index to classify prognostic comorbidity in candidates for radical prostatectomy. BMC Urol. 14, 28 (2014).
Litwin, M. S. et al. Assessment of prognosis with the total illness burden index for prostate cancer: aiding clinicians in treatment choice. Cancer 109, 1777–1783 (2007).
Droz, J. P. et al. Management of prostate cancer in older patients: updated recommendations of a working group of the International Society of Geriatric Oncology. Lancet Oncol. 15, e404–e414 (2014).
National Comprehensive Cancer Network. NCCN clinical practice guidelines in prostate cancer. [online], (2015).
Mottet, N. et al. Guidelines on prostate cancer. European Association of Urology [online], (2015).
Heidenreich, A. et al. EAU guidelines on prostate cancer. Part I: screening, diagnosis, and local treatment with curative intent — update 2013. Eur. Urol. 65, 124–137 (2014).
Heidenreich, A. et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur. Urol. 65, 467–479 (2014).
Kilari, D., Dale, W. & Mohile, S. G. How we treat early systemic prostate cancer in older men. J. Geriatr. Oncol. 5, 337–342 (2014).
Author information
Authors and Affiliations
Contributions
J.K., S.K., S.B. and A.A. researched data for the article and wrote the article, J.K., S.K. and S.B. made a substantial contribution to the discussion of content, and all authors were involved in the review/editing of the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Kalra, S., Basourakos, S., Abouassi, A. et al. The implications of ageing and life expectancy in prostate cancer treatment. Nat Rev Urol 13, 289–295 (2016). https://doi.org/10.1038/nrurol.2016.52
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrurol.2016.52
This article is cited by
-
Determination of pharmacokinetics and tissue distribution of a novel lutetium-labeled PSMA-targeted ligand, 177Lu-DOTA-PSMA-GUL, in rats by using LC–MS/MS
Scientific Reports (2022)
-
Circular RNA ITCH suppressed prostate cancer progression by increasing HOXB13 expression via spongy miR-17-5p
Cancer Cell International (2019)
-
Postoperative upgrading of prostate cancer in men ≥75 years: a propensity score-matched analysis
World Journal of Urology (2017)