Department of Urology, Akita University Graduate School of Medicine, Akita, Japan.
Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Jpn J Clin Oncol. 2022 May 31;52(6):513-525. doi: 10.1093/jjco/hyac016.
The incidence of prostate cancer among older men has increased in many countries, including Asian countries. However, older patients are ineligible for inclusion in large randomized trials, and the existing guidelines for the management of patients with prostate cancer do not provide specific treatment recommendations for older men. Therefore, generation of evidence for older patients with prostate cancer is a key imperative. The International Society of Geriatric Oncology has produced and updated several guidelines for management of prostate cancer in older men since 2010. Regarding localized prostate cancer, both surgery and radiotherapy are considered as feasible treatment options for intermediate- and high-risk prostate cancer even in older men, whereas watchful waiting and active surveillance are useful options for a proportion of these patients. With regard to advanced disease, androgen-receptor axis targets and taxane chemotherapy are standard treatment modalities, although dose modification and prevention of adverse events need to be considered. Management strategy for older patients with prostate cancer should take cognizance of not only the chronological age but also psychological and physical condition, socio-economic status and patient preferences. Geriatric assessment and patient-reported health-related quality of life are important tools for assessing health status of older patients with prostate cancer; however, there is a paucity of evidence of the impact of these tools on the clinical outcomes. Personalized management according to the patient's health status and tumour characteristics as well as socio-economic condition may be necessary for treatment of older patients with prostate cancer.
前列腺癌在许多国家包括亚洲国家的老年男性中的发病率有所增加。然而，老年患者不符合大型随机试验的纳入标准，并且现有的前列腺癌患者管理指南并未为老年男性提供特定的治疗建议。因此，为老年前列腺癌患者生成证据是当务之急。自 2010 年以来，国际老年肿瘤学会已经制定并更新了几项针对老年男性前列腺癌管理的指南。对于局限性前列腺癌，即使是老年男性，手术和放疗也被认为是中高危前列腺癌的可行治疗选择，而观察等待和主动监测对这些患者中的一部分是有用的选择。对于晚期疾病，雄激素受体轴靶向药物和紫杉烷化疗是标准的治疗方式，尽管需要考虑剂量调整和预防不良反应。老年前列腺癌患者的管理策略不仅应考虑到年龄，还应考虑到心理和身体状况、社会经济状况和患者偏好。老年肿瘤评估和患者报告的健康相关生活质量是评估老年前列腺癌患者健康状况的重要工具；然而，这些工具对临床结局的影响证据不足。根据患者的健康状况和肿瘤特征以及社会经济状况进行个体化管理可能是治疗老年前列腺癌患者所必需的。
