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  • Review Article
  • Published:

Challenges of managing elderly men with prostate cancer

Key Points

  • Elderly (aged ≥70 years) patients with prostate cancer constitute a unique patient population

  • On the one hand, elderly patients are often denied effective treatments because of fear of toxicity or diminished efficacy merely based on their age

  • On the other hand, elderly patients can be unduly subjected to intense therapies despite multiple comorbidities in the setting of indolent disease

  • It is important to individualize therapy based on the comorbidities, functional status, nutritional status and aggressiveness of disease rather than age alone

Abstract

The incidence of prostate cancer increases with age. Current evidence suggests that prostate cancer is under treated in patients aged ≥70 years, despite evidence of efficacy and acceptable toxicity. Radical cystectomy and definitive radiotherapy are often denied owing to fears of post-operative complications and radiotherapy-associated gastrointestinal and genitourinary toxicity. However, modern radical prostatectomy techniques provide excellent clinical outcomes with low perioperative morbidity. Moreover, volume-restricted intensity-modulated radiation therapy is a significant improvement over previous 2D conformal radiotherapy with similar efficacy and lower toxicity. Androgen-deprivation therapy is also under-prescribed among the elderly, owing to concerns of increases in cardiac deaths and osteoporosis acceleration. However, prospective trials have not identified any increase in cardiovascular mortality among elderly men receiving androgen-deprivation therapy compared to age-matched controls. Most patients on androgen deprivation eventually progress to a castration-resistant state. At this stage, the disease still responds to newer agents that target the androgen pathway and to chemotherapy. Among the elderly, chemotherapy is under-prescribed even though it has been demonstrated to be palliative and improve survival. We describe the trends in prostate cancer management in the elderly and the importance of assessing comorbidity status, tumour characteristics, and health status, including a complete geriatric evaluation, before making treatment recommendations.

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Figure 1: Treatment options for patients with metastatic CRPC.

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G.G.J. substantially contributed to discussion of content, wrote, reviewed and edited the manuscript before submission. V.A. researched data for the article, and made a substantial contribution to writing, reviewing and editing the manuscript before submission. A.S. researched data and contributed to writing the manuscript. B.R.K. substantially contributed to discussion of content, reviewed and edited the manuscript before submission.

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Correspondence to Badrinath R. Konety.

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Jha, G., Anand, V., Soubra, A. et al. Challenges of managing elderly men with prostate cancer. Nat Rev Clin Oncol 11, 354–364 (2014). https://doi.org/10.1038/nrclinonc.2014.71

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