title: Radical treatment of localised prostate cancer in the elderly.
abstract: Elderly men are more likely to be diagnosed with aggressive cancer, but are often inappropriately denied curative treatment. Biological rather than chronological age should be used to decide if a patient will profit from radical treatment. Therefore, every man aged >70 years should undergo a health assessment using a validated tool before making treatment decisions. Fit elderly men with intermediate- or high-risk disease should be offered standard curative local treatment in keeping with guidelines for younger men. Vulnerable and frail elderly men warrant geriatric intervention before treatment. In the case of vulnerable patients, this intervention may render them suitable for standard care. When considering radical prostatectomy outcomes a 'bifecta' of oncological control and continence is appropriate, as erectile dysfunction (although prevalent) has a much smaller impact on quality of life than in younger patients. Radiotherapy is an alternative to radical prostatectomy in men with a life expectancy of <10 years. Primary androgen-deprivation therapy is not associated with improved survival in localised prostate cancer and should only be used for symptom palliation. Further elderly-specific research is needed to guide prostate cancer care.
authors: Department of Urology, Royal Melbourne Hospital, Parkville, Vic., Australia.|Department of Surgery, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.
authors: Wouter
authors: W
authors: Everaerts
authors: Department of Urology, Royal Melbourne Hospital, Parkville, Vic., Australia.|Department of Surgery, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.
authors: Simon
authors: S
authors: Van Rij
authors: Department of Urology, Royal Melbourne Hospital, Parkville, Vic., Australia.
authors: Fairleigh
authors: F
authors: Reeves
authors: Department of Urology, Royal Melbourne Hospital, Parkville, Vic., Australia.|Epworth Healthcare Richmond, Richmond, Vic., Australia.
authors: Anthony
authors: A
authors: Costello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D007172:Erectile Dysfunction; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects / Q000401:mortality; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011788:Quality of Life; D014549:Urinary Incontinence
keywords: elderly; prostate cancer; quality of life; radical prostatectomy; radiotherapy; treatment