Management of localized prostate cancer in senior adults: the crucial role of comorbidity

  title={Management of localized prostate cancer in senior adults: the crucial role of comorbidity},
  author={John M. Fitzpatrick},
  journal={BJU International},
Prostate cancer is predominantly a disease of senior adults, i.e. those aged >70 years. With the increasing life expectancy worldwide, the burden of prostate cancer in senior adults is expected to increase. 

Prostate cancer in the elderly

The objectives of this study were to determine the frequency of metastatic (M1) prostate cancer (PC) at presentation in different age groups, to examine the association of age with PC‐specific

Cause of Death in Older Men After the Diagnosis of Prostate Cancer

To compare survival and cause of death in men aged 65 and older diagnosed with prostate cancer and with survival and death in a noncancer control population is compared.

Prostate Cancer in Seniors: Part 1: Epidemiology, Pathology, and Screening.

Patients and clinicians should carefully weigh risk factors, life expectancy, and existing medical comorbidities when making screening and treatment decisions for prostate cancer.

Comorbidity assessment in localized prostate cancer: a systematic review protocol.

This study is to review and summarize the methods and tools used to measure comorbidity in localized prostate cancer and to assess whether these tools are adequately validated and reliable for determining the impact of comorebidity on survival and treatment decisions for this disease.

Impact of race on survival in patients with clinically nonmetastatic prostate cancer who deferred primary treatment

Comparing mortality rates between African American and Caucasian American patients who deferred primary treatment for clinically nonmetastatic PCa may provide a better assessment of the impact of race on the natural course of PCa.

Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index?

To determine the safety of surveillance for localized contrast‐enhancing renal masses in elderly patients whose comorbidities precluded invasive management; to provide an insight into the natural

Laparoscopic radical prostatectomy is feasible and effective in ‘fit’ senior men with localized prostate cancer

Study Type – Therapy (case series)
Level of Evidence 4

Prostate cancer in the elderly.

Impact of age at diagnosis on prostate cancer treatment and survival.

Findings support making decisions regarding treatment on the basis of disease risk and life expectancy rather than on chronologic age, as older patients are more likely to have high-risk prostate cancer at diagnosis and less likely to receive local therapy.

Older Men with Intermediate to High Risk Prostate Cancer-Patterns of Care and Outcomes of Treatment

The oldest patients with prostate cancer do just as well as younger patients with any given treatment modality, and have similar cancer specific survival with hormone therapy as they do with radiation or surgery.



Fracture risk in Danish men with prostate cancer: a nationwide register study

A nationwide Danish study on the risk of fractures in prostate cancer, as well as assessing the impact of exposure to androgen deprivation, found that there was a marked increase in therisk of fractures, especially of the hip.

The impact of age and comorbidity on survival outcomes and treatment patterns in prostate cancer

The importance of age and comorbidity on treatment decisions and survival outcomes in prostate cancer, as well as their use as objectively quantifiable variables are reviewed.

Survival associated with treatment vs observation of localized prostate cancer in elderly men.

A survival advantage is associated with active treatment for low- and intermediate-risk prostate cancer in elderly men aged 65 to 80 years, and a benefit associated with treatment was seen in all subgroups examined.

Factors that determine the treatment for local and regional prostate cancer.

Age was the most important predictor of therapeutic choice; no therapy was given to 26% of men 65 to 69 years old versus 63% ofMen 85 years or older P < 0.001; race, residence, and comorbidity were also strong factors in predicting initial therapy.

Time trends and characteristics of men choosing watchful waiting for initial treatment of localized prostate cancer: results from CaPSURE.

During the prostate specific antigen era rates of WW for the initial treatment of prostate cancer have been decreasing despite considerable downward stage migration, and it is expected that as prostate cancer risk assessment and surveillance strategies continue to improve, more patients may benefit from this approach to management.

Competing Risk Analysis of Men Aged 55 to 74 Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer

Estimation of survival based on a competing risk analysis stratified by age at diagnosis and histologic findings for men diagnosed as having clinically localized prostate cancer and who were managed conservatively finds men whose prostate biopsy specimens show Gleason score 2 to 4 disease face a minimal risk of death from prostate cancer within 15 years of diagnosis.