Don’t overlook the elderly for prostate cancer treatment
Prostate cancer is a common malignancy in men with a predilection for the elderly. Despite this, many prostate cancer medical trials under-represent the geriatric population and there is a risk of under treatment within this age group. The associated article ‘Radiotherapy in elderly patients with prostate cancer’ attempts to guide clinicians through the management of the geriatric prostate cancer patient with specific focus on the role of radical radiotherapy.
Key to the treatment of the geriatric prostate cancer patient is a comprehensive medical review that can give the clinician confidence that the patient has the medical robustness to tolerate the therapy being offered. The comprehensive geriatric assessment tool (CGA) is widely used and reported on but it can be cumbersome in a busy clinical setting. The International Society of Geriatric Oncology (SIOG) favoured G8 assessment is quicker to use and guides the clinician as to when further specialist geriatric assessment should be sought to optimise individual patients.
While the role of adjuvant androgen deprivation therapy in the elderly prostate cancer patient maybe more controversial, there is an increasing body of evidence that appropriately assessed geriatric patients not only tolerate radical radiotherapy well but gain a survival advantage compared to their peers treated with palliative intent alone. It is important that clinicians do not decide therapy based on patient chronological age alone and I would point anyone who is interested in further reading to the recommendations of a task force of the SIOG on the management of prostate cancer (click here). Wherever possible, clinical trials should be designed to include geriatric patients to develop the evidence base.
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