[Metastatic prostate cancer treatment in the elderly].
Incidence and mortality of prostate cancer increase with age. This epidemiologic trend and disease's natural history, extending on 10 to 15 years, explain that a majority of patients are old (more than 70 years) to very old (more than 80 years) at the metastatic stage. Moreover, when a geriatric screening is done, oncogeriatric parameters are often disturbed, justifying both an oncologic and a geriatric approaches. But the strength of co-morbidities does not justify a systematic under-treatment, because a patient older than 70 years and suffering from prostate cancer on two will die from his cancer, often with a painful symptomatology. As for a younger patient, the disease is hormono-sensitive during 18 to 24 months, before it becomes androgeno-resistant. The treatment, simple castration, complete hormonal blocking or anti-androgens alone, was not evaluated specifically in the elderly. Clinical and biological response to hormonal manipulation is often short and this procedure should not delay chemotherapy, when patient's clinical status allows it, in order mainly to reduce clinical symptoms. Docetaxel showed, in TAX427 study, a better control of clinical symptoms than mitoxantrone and also an increase in patients'survival. In the subgroup of patients older than 70, hematologic toxicities are more frequent and justify a G-CSF prophylaxy, according to international recommendations; on the opposite, non-hematologic toxicities are as frequent as in the younger subgroup. When bone metastases are symtomatic, some treatments can associate or follow a chemotherapy: bisphosphonates, radiotherapy and metabolic radiotherapy. These treatments have specific toxicities and must be specifically supervised in the elderly (bisphosphonates can worsen a renal insufficiency and metabolic radiotherapy induces frequently a limitant hematotoxicity). Lastly, new molecules are currently under evaluation. Current or future studies, according to international recommendations, must include elderly patients and avoid restrictive exclusion criteria.
Falandry
Claire
C
Service d'oncologie médicale, Centre hospitalier Lyon-Sud, Faculté de Médecine Lyon-Sud, Université Lyon 1. claire.falandry@chu-lyon.fr
Bonnefoy
Marc
M
You
Benoît
B
Freyer
Gilles
G
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008297:Male; D009376:Neoplasms, Hormone-Dependent / Q000628:therapy; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods
D000726:Androgen Antagonists; D000970:Antineoplastic Agents