Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults.
BACKGROUND
The incidence of prostate cancer increases with age, with a median age at diagnosis of 68 years. Owing to increased life expectancy, the management of prostate cancer in senior adult men (i.e., aged 70 years or older) represents an important public health concern and a major challenge for the future. No specific guidelines have previously been published on the management of prostate cancer in older men. The SIOG has developed a proposal of recommendations in this setting.


METHODS
A systematic bibliographical search focused on screening, diagnostic procedures, treatment options for localised, locally advanced and metastatic prostate cancer in senior adults was performed. Specific aspects of the geriatric approach were emphasised, including evaluation of health status (nutritional, cognitive, thymic, physical and psycho-social) and screening for vulnerability and frailty. Attention was drawn to the consequences of androgen deprivation and complications of local treatment, mainly incontinence. The collected material has been reviewed and discussed by a scientific panel including urologists, radiation oncologists, medical oncologists and geriatricians from both Europe and North America.


RESULTS
The consensus is to use either European Association of Urology or National Comprehensive Cancer Network clinical recommendations for prostate cancer treatment and to adapt them to health status based on instrumental activities of daily living (IADL) and activities daily living (ADL), comorbidity evaluation by Cumulative Illness Scoring Rating-Geriatrics and screening for malnutrition. Patients in Group 1 (no abnormality) are 'fit' and should receive the same treatment as younger patients; patients in Group 2 (one impairment in IADL or one uncontrolled comorbidity or at risk of malnutrition) are 'vulnerable' and should receive standard treatment after medical intervention; patients in Group 3 (one impairment in ADL or more than one uncontrolled comorbidity or severe malnutrition) are 'frail' and should receive adapted treatment; patients in Group 4 (dependent) should receive only symptomatic palliative treatment.


CONCLUSIONS
Treatment of prostate cancer in senior adults should be adapted to health status. Specific prospective studies in this setting are warranted.
Droz
Jean-Pierre
JP
Department of Medical Oncology, Centre Léon-Bérard, 69008 Lyon, France. jpdroz@orange.fr
Balducci
Lodovico
L
Bolla
Michel
M
Emberton
Mark
M
Fitzpatrick
John M
JM
Joniau
Steven
S
Kattan
Michael W
MW
Monfardini
Silvio
S
Moul
Judd W
JW
Naeim
Arash
A
van Poppel
Hendrik
H
Saad
Fred
F
Sternberg
Cora N
CN
D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*