Department of Urology General Hospital Celje, Slovenia
Prostate cancer is the most common cancer in eldery males. The median age at diagnosis is 68 years and for prostate cancer related death at 75 years. Older men are more likely to be diagnosed with more aggressive disease and more likely to die from prostate cancer than younger men. In clinical practice, treatment decisions are predominantly influenced by patientsʹ life expectancy and tumor histology. There is a difficulty to estimate patientsʹ life expectancy after initial cancer diagnosis. Geriatric oncology guidelines recommend that treatment decision in prostate cancer should be based on the patientsʹ physiological age and not on chronological age. Fit older men should be offered the same treatment options as their younger counterparts.
G8 (Geriatric 8) health status screening tool to determite health status.
Above 14, patients are considered fit and should receive the same treatment as younger patients.
Active treatments are of most benefit to patients with intermediate- or high risk disease. The upper age limit for radical prostatectomy for clinically localised prostate cancer is not clearly defined. There are few reports of radical prostatectomy in eldery population. Radical prostatectomy in senior adults with few comorbidities has shown to improve live expectancy in intermediate- and high risk disease. The risk of postoperative mortality after radical prostatectomy is relatively low for otherwise healthy older man up to age 79. Eldery men have similar perioperative and functional results.
Radical prostatectomy (including robotic) is safe and feasible in selected eldery men. Advanced chronological age is not an absolute contraindication for these patients.
Fitzpatrick JM. Management of localized prostate cancer in senior adult: The crucial role of comorbidity. BJU Int 2008; 10: 16-22
Greco KA, Meeks JJ, Wu S, et al. Robot-assisted radical prostatectomy in men aged ˃ 70 years. BJU Int 2009; 104: 1492-5
AStangelberger A, Waldert M, Djavan B. prostate cancer in eldery men. Rev Urol 2008;10:111-9
Menon M et al. RARP for eldery patients with high risk prostate cancer. Urol. Oncol. 2013; 31:193-7
European Association of Urology. Guidelines, Edition 2014