Everaerts Wouter, Van Rij Simon, Reeves Fairleigh, Costello Anthony
Department of Urology, Royal Melbourne Hospital, Parkville, Vic., Australia.
Department of Surgery, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.
BJU Int. 2015 Dec;116(6):847-52. doi: 10.1111/bju.13128. Epub 2015 Jun 3.
Elderly men are more likely to be diagnosed with aggressive cancer, but are often inappropriately denied curative treatment. Biological rather than chronological age should be used to decide if a patient will profit from radical treatment. Therefore, every man aged >70 years should undergo a health assessment using a validated tool before making treatment decisions. Fit elderly men with intermediate- or high-risk disease should be offered standard curative local treatment in keeping with guidelines for younger men. Vulnerable and frail elderly men warrant geriatric intervention before treatment. In the case of vulnerable patients, this intervention may render them suitable for standard care. When considering radical prostatectomy outcomes a 'bifecta' of oncological control and continence is appropriate, as erectile dysfunction (although prevalent) has a much smaller impact on quality of life than in younger patients. Radiotherapy is an alternative to radical prostatectomy in men with a life expectancy of <10 years. Primary androgen-deprivation therapy is not associated with improved survival in localised prostate cancer and should only be used for symptom palliation. Further elderly-specific research is needed to guide prostate cancer care.
老年男性更有可能被诊断出患有侵袭性癌症，但他们常常被不恰当地拒绝接受根治性治疗。应依据生物学年龄而非实际年龄来决定患者是否能从根治性治疗中获益。因此，每位70岁以上的男性在做出治疗决策前都应使用经过验证的工具进行健康评估。身体状况良好、患有中高危疾病的老年男性应按照针对年轻男性的指南接受标准的根治性局部治疗。脆弱和体弱的老年男性在治疗前需要老年病学干预。对于脆弱患者，这种干预可能会使他们适合接受标准治疗。在考虑根治性前列腺切除术的结果时，采用肿瘤控制和控尿的“双达标”是合适的，因为勃起功能障碍（尽管很常见）对生活质量的影响比年轻患者小得多。对于预期寿命小于10年的男性，放射治疗是根治性前列腺切除术的替代方案。一线雄激素剥夺疗法与局限性前列腺癌患者生存率的提高无关，仅应用于缓解症状。需要开展更多针对老年人的研究来指导前列腺癌的治疗。
