Droz Jean-Pierre, Chaladaj Agnieska
Department of Medical Oncology, Centre Léon-Bérard, Lyon, France.
BJU Int. 2008 Mar;101 Suppl 2:23-9. doi: 10.1111/j.1464-410X.2007.07486.x.
Prostate cancer predominantly affects older men, with a median age at diagnosis of 68 years. Due to the increased life expectancy, management of prostate cancer in senior adults (aged >70 years) represents a major public health problem. This patient population may not receive optimal therapy for their disease, if decisions are made based on their chronological age alone. More so than age alone, health status is a major factor affecting individual life expectancy. Comorbidity is the key predictor of health status and should weigh more heavily on the treatment decision than age alone. Other important parameters to consider in senior adults are the degree of dependence in activities of daily living, the nutritional status and the presence or not of a geriatric syndrome. Although clinical trials are rarely designed specifically for senior adults, evidence suggests that healthy senior adults have similar treatment outcomes to their younger counterparts. The urological approach in senior adults with advanced prostate cancer should be fundamentally the same as in younger patients. In hormone-sensitive metastatic prostate cancer, androgen deprivation represents the first-line treatment. In senior adults, care should be given to the increased risk of metabolic syndrome, cardiovascular mortality and bone fracture. In hormone-refractory metastatic prostate cancer, chemotherapy with docetaxel (75 mg/m(2) every 3 weeks) plus low-dose prednisone is the standard and shows the same efficacy in healthy senior adults as in younger patients. The tolerance of docetaxel (3-weekly schedule) has not been specifically studied in vulnerable and frail senior adults. The place of weekly docetaxel in this setting should be further evaluated. Palliative treatments (palliative surgery, radiopharmaceutics, radiotherapy, medical treatments for pain and symptoms, pharmacological palliative therapies) should also be integrated in the global management of these patients. In conclusion, treatment decisions in senior adults should be adapted to health status. Healthy senior adults should be treated the same as younger patients. The development of guidelines for the management of localized and advanced prostate cancer in senior adults is underway.
前列腺癌主要影响老年男性，诊断时的中位年龄为68岁。由于预期寿命的增加，老年成年人（年龄>70岁）前列腺癌的管理成为一个重大的公共卫生问题。如果仅根据实际年龄做出决策，这一患者群体可能无法获得针对其疾病的最佳治疗。影响个体预期寿命的主要因素不仅仅是年龄，健康状况更是关键。合并症是健康状况的关键预测指标，在治疗决策中应比单纯年龄更具权重。在老年成年人中还需考虑的其他重要参数包括日常生活活动的依赖程度、营养状况以及是否存在老年综合征。尽管很少有专门针对老年成年人设计的临床试验，但有证据表明健康的老年成年人与年轻患者的治疗结果相似。老年晚期前列腺癌患者的泌尿外科治疗方法应与年轻患者基本相同。在激素敏感性转移性前列腺癌中，雄激素剥夺是一线治疗方法。对于老年成年人，应关注代谢综合征、心血管死亡率和骨折风险增加的问题。在激素难治性转移性前列腺癌中，多西他赛（每3周75 mg/m²）联合低剂量泼尼松化疗是标准治疗方法，在健康老年成年人中的疗效与年轻患者相同。多西他赛（每3周方案）在脆弱和体弱的老年成年人中的耐受性尚未进行专门研究。在这种情况下，每周多西他赛的应用位置应进一步评估。姑息治疗（姑息性手术、放射性药物、放疗、疼痛和症状的药物治疗、药理姑息治疗）也应纳入这些患者的整体管理中。总之，老年成年人的治疗决策应根据健康状况进行调整。健康的老年成年人应与年轻患者接受相同的治疗。针对老年成年人局限性和晚期前列腺癌管理的指南正在制定中。
