Northwestern University, Chicago, IL, USA.
Northwestern University, Chicago, IL, USA.
Eur Urol Oncol. 2020 Aug;3(4):400-409. doi: 10.1016/j.euo.2020.03.006. Epub 2020 May 26.
Treatment decisions for elderly men with prostate cancer are complicated by the intersection of competing risks of cancer, potential complications of treatment, and individual patients' comorbidities.
To perform a systematic review of data guiding the assessment of elderly prostate cancer patients that addresses the risk from cancer and treatment, and to discuss a patient-centered approach to incorporating these factors into decision making.
Evidence was gathered via a systematic review of the current literature. The search strategy used the terms prostate cancer, elderly, geriatric, >75 yr of age, risk assessment, and treatment in several combinations, and was limited to phase ≥ II clinical trials published between January 2008 and November 2018. Additional supporting literature for the discussion was pulled by hand search.
The benefits of treatment identified for systemic therapies commonly used to treat men with prostate in general extend to elderly patients. Evidence supports a multifaceted assessment of the risks of cancer and aging, and an understanding of the side effects of treatment to optimally guide therapeutic decision making for elderly patients. There is little evidence defining a geriatric risk stratification system specific to prostate cancer, and recommendations are predominantly based on adapted geriatric oncology approaches and expert consensus.
The care of elderly men with prostate cancer should incorporate a review of cancer risk, an assessment of aging, and an understanding of the effects of treatment to provide the patient with thorough and personalized guidance for treatment decisions. Future studies of elderly men with prostate cancer can define and validate ideal risk stratification methods as well as management approaches that may be distinct from those for younger populations.
Treatment decisions for elderly men with prostate cancer require consideration of the risk posed by the cancer coupled with an understanding of the patient's general health status.
老年男性前列腺癌的治疗决策受到癌症风险、治疗潜在并发症以及患者合并症等多种因素的影响。
对评估老年前列腺癌患者的相关数据进行系统回顾，这些数据可以明确癌症和治疗带来的风险，并讨论一种以患者为中心的方法，将这些因素纳入决策过程。
通过对当前文献进行系统回顾来获取证据。检索策略使用了前列腺癌、老年、老年病学、>75 岁、风险评估和治疗等术语，并以 2008 年 1 月至 2018 年 11 月期间发表的≥Ⅱ期临床试验为限进行了多种组合。通过手动搜索进一步获取了讨论所需的其他支持文献。
通常用于治疗前列腺癌的全身性治疗方法所带来的获益也适用于老年患者。有证据支持对癌症和衰老风险进行多方面评估，并了解治疗的副作用，从而为老年患者提供最佳的治疗决策指导。虽然有一些证据可以定义一种特定于前列腺癌的老年风险分层系统，但主要建议还是基于改良的老年肿瘤学方法和专家共识。
老年男性前列腺癌患者的治疗应该综合评估癌症风险、衰老状况，并了解治疗的影响，从而为患者提供全面、个性化的治疗决策指导。未来针对老年男性前列腺癌患者的研究可以确定并验证理想的风险分层方法，以及可能与年轻人群不同的管理方法。
老年男性前列腺癌的治疗决策需要综合考虑癌症风险，以及患者的整体健康状况。
