International recommendations on treatment of “older” men

A Prostate Cancer Task Force of the International Society of Geriatric Oncology (SIOG) has just issued new recommendations on the management of prostate cancer in “older men” (by which the task force means men of more than 70 years of age).

A background document associated with this topic was published by the task force in January this year, and the detailed recommendations appear in the March issue of BJU International. Unfortunately the full recommendations do not appear to be available on line on the SIOG web site, which is a pity.

The basic consensus statement of the Task Force can be summarized as follows:

  • Older men with prostate cancer should be managed according to their overall, individual health status,  and not solely according to their chronological age.
  • Existing international recommendations should be the basic backbone for treatment of localized and advanced disease, but should be adapted to patient health status.
  • Patients can be broadly classified into four different groups:
    • “Healthy” patients (controlled comorbidity, fully independent in daily living activities, no malnutrition), who should receive the same treatment as younger patients
    • “Vulnerable” patients (with manageable or “reversible” clinical status), who should receive standard treatment for their prostate cancer after medical intervention for their other conditions
    • “Frail” patients (with “irreversible” forms of impairment), should receive modified forms of treatment for their prostate cancer
    • Patients who are “too sick” because of some form of “terminal illness” and who should receive only symptomatic, palliative therapy.

In referring to “existing international recommendations” the task force specifically calls out guidance documents issued by the European Association of Urology, the National Comprehensive Cancer Network, and the American Urological Association. It is therefore clear that the task force is not attempting to develop new guidelines for older patients. What they are doing in encouraging a clinical approach based on individual characteristics of specific patients — in other words, the personalization of care and the treatment of the patient as a whole person, not just his prostate cancer.

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