Urologie pro praxi 3/2022

Therapy of prostate cancer in elderly patients

The median age at the time of diagnosis of prostate cancer (PC) in the Czech Republic is 68 years. The risk of PC increases with age. In older patients, the tumor is more often detected at an advanced stage. A basic geriatric assessment should be done in all patients older than 70 years. Basic screening tools used in geriatrics include the Geriatric 8 (G8) test. Based on this test, we discriminate between patients who are fit, vulnerable and frail. Radical treatment comparable to younger ones should be offered to all fit patients and those vulnerable with reversible impairment. Frail patients with irreversible impairment should receive adapted treatment and those who are too ill should receive only best supportive care. Watchful waiting is the ideal choice for men with low– and medium–risk PC and comorbidities limiting active therapy. Radical treatment is burdened with a higher rate of immediate and long–term complications in older patients. Androgen deprivation therapy is accompanied by a number of long–term metabolic, cardiovascular and other side effects. New hormonal agents have demonstrated similar clinical efficacy and a relatively favorable safety profile in elderly patients compared to younger subgroups. In any case, calendar age as a factor alone should not guide our indication for treatment of PC.

Keywords: prostate cancer, life expectancy, geriatric assessment, elderly patient.