Heinzer Hans, Steuber Thomas
Martini-Klinik, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Urol Oncol. 2009 Nov-Dec;27(6):668-72. doi: 10.1016/j.urolonc.2009.07.015.
Prostate cancer is the most frequent malignancy in men and predominantly in elderly men. The issue of prostate cancer is likely to assume greater importance with progressive aging of the population. With frequent use of PSA testing most patients were diagnosed with localized cancer even in senior adults. Cancer-specific mortality is low in elderly men with prostate cancer and is dependent on the aggressiveness of the tumor. Currently, no established guidelines for the management of prostate cancer in the elderly exist, and treatment of senior adults with localized cancer is not optimal. While elderly men with indolent disease will not benefit from curative treatment, some patients with aggressive cancers will progress if not adequately treated. Comorbidity is the main predictor of life expectancy in the elderly. In everyday clinical practice, treatment decisions are much more influenced by age than by comorbidity. Curative treatment is an effective treatment option for selected elderly with localized prostate cancer. Conversely, most elderly men with prostate cancer received hormonal therapy, although the benefit of hormonal therapy in localized cancer is not clear and is associated with severe toxicities in some patients. In conclusion, there is a need for more risk stratified approaches for the management of prostate cancer in the elderly to avoid unnecessary intervention in men who unlikely benefit from such intervention, and allow treatment in those who might benefit from it.
前列腺癌是男性中最常见的恶性肿瘤，主要发生在老年男性中。随着人口的不断老龄化，前列腺癌问题可能会变得更加重要。由于频繁使用前列腺特异性抗原（PSA）检测，即使在老年人中，大多数患者也被诊断为局限性癌症。前列腺癌老年男性的癌症特异性死亡率较低，且取决于肿瘤的侵袭性。目前，尚无针对老年人前列腺癌管理的既定指南，对局限性癌症老年患者的治疗并不理想。虽然患有惰性疾病的老年男性无法从根治性治疗中获益，但一些侵袭性癌症患者若未得到充分治疗将会进展。合并症是老年人预期寿命的主要预测因素。在日常临床实践中，治疗决策受年龄的影响远大于合并症。根治性治疗是部分局限性前列腺癌老年患者的有效治疗选择。相反，大多数前列腺癌老年男性接受了激素治疗，尽管激素治疗在局限性癌症中的益处尚不明确，且在一些患者中会伴有严重毒性。总之，需要更多风险分层方法来管理老年人前列腺癌，以避免对不太可能从此类干预中获益的男性进行不必要的干预，并使可能从中获益的患者得到治疗。
