Cancer-Environment Research Unit, Centre Léon-Bérard and Claude-Bernard Lyon 1 University, Lyon, France.
Groupement Hospitalier Sud des Hospices Civils de Lyon, Hôpital Antoine Charial, Francheville, France.
Eur Urol. 2017 Oct;72(4):521-531. doi: 10.1016/j.eururo.2016.12.025. Epub 2017 Jan 11.
Prostate cancer is the most frequent male cancer. Since the median age of diagnosis is 66 yr, many patients require both geriatric and urologic evaluation if treatment is to be tailored to individual circumstances including comorbidities and frailty.
To update the 2014 International Society of Geriatric Oncology (SIOG) guidelines on prostate cancer in men aged >70 yr. The update includes new material on health status evaluation and the treatment of localised, advanced, and castrate-resistant disease.
A multidisciplinary SIOG task force reviewed pertinent articles published during 2013-2016 using search terms relevant to prostate cancer, the elderly, geriatric evaluation, local treatments, and castration-refractory/resistant disease. Each member of the group proposed modifications to the previous guidelines. These were collated and circulated. The final manuscript reflects the expert consensus.
Elderly patients should be managed according to their individual health status and not according to age. Fit elderly patients should receive the same treatment as younger patients on the basis of international recommendations. At the initial evaluation, screening for cognitive impairment is mandatory to establish patient competence in making decisions. Initial evaluation of health status should use the validated G8 screening tool. Abnormal scores on the G8 should lead to a simplified geriatric assessment that evaluates comorbid conditions (using the Cumulative Illness Score Rating-Geriatrics scale), dependence (Activities of Daily Living) and nutritional status (via estimation of weight loss). When patients are frail or disabled or have severe comorbidities, a comprehensive geriatric assessment is needed. This may suggest additional geriatric interventions.
Advances in geriatric evaluation and treatments for localised and advanced disease are contributing to more appropriate management of elderly patients with prostate cancer. A better understanding of the role of active surveillance for less aggressive disease is also contributing to the individualisation of care.
Many men with prostate cancer are elderly. In the physically fit, treatment should be the same as in younger patients. However, some elderly prostate cancer patients are frail and have other medical problems. Treatment in the individual patient should be based on health status and patient preference.
前列腺癌是男性最常见的癌症。由于中位诊断年龄为 66 岁，如果要根据个体情况（包括合并症和虚弱程度）来定制治疗方案，许多患者需要接受老年病学和泌尿科评估。
更新 2014 年国际老年肿瘤学会（SIOG）关于 70 岁以上男性前列腺癌的指南。更新内容包括健康状况评估和局部、晚期和去势抵抗性疾病治疗方面的新材料。
一个多学科的 SIOG 工作组使用与前列腺癌、老年人、老年评估、局部治疗和去势抵抗/难治性疾病相关的搜索词，回顾了 2013-2016 年期间发表的相关文章。小组成员每人都提出了对前指南的修改建议。这些建议被整理并传阅。最终的手稿反映了专家的共识。
应根据个体健康状况而非年龄来管理老年患者。根据国际建议，健康的老年患者应与年轻患者一样接受相同的治疗。在初始评估时，必须筛查认知障碍以确定患者在决策中的能力。健康状况的初始评估应使用经过验证的 G8 筛查工具。G8 得分异常应导致简化的老年评估，评估合并症（使用累积疾病评分-老年量表）、依赖性（日常生活活动）和营养状况（通过估计体重减轻）。当患者虚弱或残疾或患有严重合并症时，需要进行全面的老年评估。这可能表明需要进行额外的老年干预。
老年评估和局部及晚期疾病治疗方面的进展正在促进对前列腺癌老年患者的更恰当管理。对侵袭性较低疾病的主动监测作用的认识加深，也有助于实现个体化治疗。
许多患有前列腺癌的男性都已步入老年。在身体状况良好的情况下，治疗应与年轻患者相同。然而，一些老年前列腺癌患者身体虚弱，还有其他健康问题。患者的治疗应根据健康状况和患者的意愿来决定。
