Department of Surgery, Mater Misericordiae Hospital and University College Dublin, Irish Cancer Society, 43/45 Northumberland Road, Dublin 4, Ireland.
Oncologist. 2012;17 Suppl 1(Suppl 1):31-5. doi: 10.1634/theoncologist.2012-S1-31.
Largely a disease of older men, prostate cancer is likely to become a growing burden in the developed world as the population ages and overall life expectancy increases. Furthermore, prostate cancer management in older men is not optimal, reflecting the lack of training dedicated to senior adults in fellowship programs and the lack of specific guidelines to manage senior adults. The International Society of Geriatric Oncology (SIOG) convened a multidisciplinary Prostate Cancer Working Group to review the evidence base and provide advice on the management of the disease in senior age groups. The Working Group reported that advancing age, by itself, is not a reliable guide to treatment decision making for men with either localized or advanced prostate cancer. Instead, the SIOG guidelines advise health care teams to assess the patient's underlying health status, which is largely dictated by associated comorbid conditions, but also by dependency in activities of daily living and nutritional status, and to use the findings to categorize the individual into one of four groups: healthy, vulnerable, frail, or terminally ill. The guidelines recommend that a patient categorized as healthy or vulnerable (i.e., with reversible problems following geriatric intervention) should receive the same approach to treatment as a younger patient. Frail patients should be managed using adapted treatment strategies, and the terminally ill should receive symptomatic/palliative care only. The guidelines may have ongoing relevance as the treatment options for prostate cancer expand.
前列腺癌主要发生于老年男性，随着人口老龄化和预期寿命的延长，前列腺癌在发达国家的发病率将不断增加，其负担也将不断加重。此外，由于老年男性相关培训项目缺乏对老年人的专门培训，以及缺乏专门针对老年人的管理指南，前列腺癌的治疗效果并不理想。国际老年肿瘤学会（SIOG）召集了一个多学科前列腺癌工作组，对现有证据进行了审查，并就老年患者前列腺癌的管理提供了建议。工作组报告称，对于局限性或晚期前列腺癌患者，年龄增长本身并不能作为治疗决策的可靠依据。相反，SIOG 指南建议医疗团队评估患者的基础健康状况，这主要取决于合并症情况，但也取决于日常生活活动的依赖性和营养状况，并根据这些评估结果将患者分为以下 4 个组别之一：健康、脆弱、虚弱或终末期。指南建议，将被归类为健康或脆弱（即经过老年干预后可逆转的问题）的患者应接受与年轻患者相同的治疗方法。虚弱的患者应采用适应性治疗策略进行治疗，而终末期患者则仅接受对症/姑息治疗。随着前列腺癌治疗方法的不断扩展，这些指南可能会持续具有重要意义。
