THE "NEW" PROSTATE CANCER INFOLINK

A helpful review article on the treatment of metastatic and metastatic, castration-resistant prostate cancer (mCRPC) in very elderly men appears in last month’s issue of Clinical Interventions in Aging. A PDF copy of the entire text of this article can be downloaded if you click here. We suspect that this article may be a useful resource for many prostate cancer educators, support group leaders, and others. You can also just see the abstract if you click here.

Because the entire article is available on line for interested readers, we shan’t get into a lot of detail. Suffice it to say that the authors (Caffo et al.) offer a thorough summary of current guidance from both the US-based National Comprehensive Cancer Network (NCCN) and the Europe-based International Society of Geriatric Oncology (SIOG) on the treatment of older men with advanced forms of prostate cancer, most particularly with reference to those of 75 to 85 years of age and > 85 years of age.

Key issues discussed in this article include the following:

• Use of the Comprehensive Geriatric Assessment (CGA) process and tools  and other instruments like the G8 score in evaluation and classification of the patient
• Categorization of patients as
  • Elderly but fit (with a G8 score of > 14)
  • Elderly but vulnerable (with a G8 score of ≤ 14 but potentially still able to receive certain types of standard treatments if appropriately managed)
  • Elderly but frail (with a G8 score of ≤ 14 but potentially capable of receiving adapted forms of standard treatments if appropriately managed)
• Data on the outcomes of elderly patients (≥ 75 years of age) from major clinical trials of drugs like docetaxel, cabazitaxel, abiraterone acetate, enzalutamide, radium-223, and sipuleucel-T
• Side effects of the drugs itemized in patients ≥ 75 years of age
• Discussion of the above-mentioned data for each of the drugs itemized

The authors also conclude by recommending that:

The cutoff age for defining elderly mCRPC patients should be moved to 80 years. In everyday clinical practice, this special population should be treated on the basis of the results of careful geriatric and comorbidity evaluation, and should be not excluded from new treatments simply because of their chronological age.

They also suggest that:

 … specific trials should be designed in order to extend the possibility for very elderly mCRPC patients to receive treatments that prolong their survival.

Filed under: Living with Prostate Cancer, Management, Treatment | Tagged: castration-resistant, elderly, guideline, metastatic, Treatment |