Division of Medical Oncology, University of Colorado, Aurora, CO.
The University of Texas MD Anderson Cancer Center, Houston, TX.
Am Soc Clin Oncol Educ Book. 2023 May;43:e390396. doi: 10.1200/EDBK_390396.
The majority of men with prostate cancer are diagnosed when they are older than 65 years; however, clinical trial participants are disproportionately younger and more fit than the real-world population treated in typical clinical practices. It is, therefore, unknown whether the optimal approach to prostate cancer treatment is the same for older men as it is for younger and/or more fit men. Short screening tools can be used to efficiently assess frailty, functional status, life expectancy, and treatment toxicity risk. These risk assessment tools allow for targeted interventions to increase a patient's reserve and improve treatment tolerance, potentially allowing more men to experience the benefit of the significant recent treatment advances in prostate cancer. Treatment plans should also take into consideration each patient's individual goals and values considered within their overall health and social context to reduce barriers to care. In this review, we will discuss evidence-based risk assessment and decision tools for older men with prostate cancer, highlight intervention strategies to improve treatment tolerance, and contextualize these tools within the current treatment landscape for prostate cancer.
大多数患有前列腺癌的男性都是在 65 岁以上被诊断出来的；然而，临床试验参与者比实际治疗中在典型临床实践中的人群年轻且更健康。因此，尚不清楚对于老年男性来说，前列腺癌治疗的最佳方法是否与年轻和/或更健康的男性相同。简短的筛选工具可用于有效地评估虚弱、功能状态、预期寿命和治疗毒性风险。这些风险评估工具可进行针对性干预，以增加患者的储备并提高治疗耐受性，从而使更多的男性能够受益于前列腺癌治疗方面的重大近期进展。治疗计划还应考虑到每个患者的个人目标和价值观，这些目标和价值观要考虑到他们整体的健康和社会背景，以减少治疗障碍。在这篇综述中，我们将讨论针对患有前列腺癌的老年男性的基于证据的风险评估和决策工具，强调改善治疗耐受性的干预策略，并将这些工具置于当前的前列腺癌治疗环境中。
