Centre Hospitalo-Universitaire de Saint Etienne, Saint Etienne, France.
Drugs Aging. 2022 Sep;39(9):685-694. doi: 10.1007/s40266-022-00973-8. Epub 2022 Aug 26.
Following a treatment with curative intent, a biochemical recurrence may be diagnosed, often many years after the primary treatment. The consequences of this relapse on survival are very heterogeneous. The expected specific survival at relapse is above 50% at 10 years. Therefore, its management needs to be balanced with the individual life expectancy. The relapse needs to be categorized as either a low- or high-risk category. The latter has to be considered for salvage therapy, provided the individual life expectancy is long enough. It is evaluated through an initial geriatric assessment, starting with the G8 score as well as the mini-Cog. A comprehensive geriatric assessment might be needed based on the G8 score. Patients will then be categorized as either fit, vulnerable, or frail. If a local salvage therapy is considered, the relapse localization might be of interest in some situations. Available salvage therapies in senior adults have nothing special compared to salvage of younger men, except for aggressive local therapy, which might be less well tolerated. The key objective in managing a biochemical recurrence in senior adults is to find the right balance between under- and over-treatment in a shared decision process. In many frail and vulnerable men, a clinically oriented watchful waiting should be preferred, while fit men with an aggressive relapse and a significant life expectancy need an active therapy.
在有治愈意图的治疗后，可能会诊断出生化复发，通常在原发治疗后多年。这种复发对生存的影响非常不一致。复发 10 年后的预期特定生存率超过 50%。因此，其管理需要与个体预期寿命相平衡。复发需要分为低风险或高风险类别。如果个体预期寿命足够长，则需要考虑后者进行挽救性治疗。通过初始老年评估进行评估，首先是 G8 评分和 mini-Cog。如果 G8 评分需要，可能需要进行全面的老年评估。患者将被归类为健康、脆弱或虚弱。如果考虑局部挽救性治疗，在某些情况下，复发定位可能会很有意义。与年轻男性相比，老年患者的挽救性治疗没有什么特别之处，除了侵袭性局部治疗，后者可能耐受性较差。在老年患者中管理生化复发的主要目标是在共同决策过程中找到过度治疗和治疗不足之间的正确平衡。在许多虚弱和脆弱的男性中，应优先考虑临床导向的观察等待，而对于具有侵袭性复发和显著预期寿命的健康男性，则需要积极治疗。
