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Prostate Cancer Treatment For 80 Year Old

What Questions Should I Ask My Healthcare Provider

Older Men and Prostate Cancer

If you have prostate cancer, you may want to ask your healthcare provider:

  • Why did I get prostate cancer?
  • What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
  • Has the cancer spread outside of the prostate gland?
  • What is the best treatment for the stage of prostate cancer I have?
  • If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
  • What are the treatment risks and side effects?
  • Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
  • Am I at risk for other types of cancer?
  • What type of follow-up care do I need after treatment?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.

Are Older Men Undertreated

Schwartz and colleagues reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.

Thompson and colleagues investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.

Does Overdiagnosis Lead To Overtreatment Of Older Men

The widespread use of PSA screening has led to an increase in the diagnosis and treatment of early localized prostate cancer. Data from the US Cancer of the Prostate Strategic Urological Research Endeavor database suggest a significant decrease in risk in the last 2 decades in the United States, with more patients being identified with low-risk disease at diagnosis, but the role of active treatment of low- and intermediate-risk disease in elderly men remains controversial.

The median time from diagnosis to death from prostate cancer for men with nonpalpable disease is approximately 17 years., Considering that the US male life expectancy at the age of 65 years is 16 years, aggressive therapy will hardly extend life expectancy of older men with no palpable prostate cancer at the time of diagnosis. Twenty to 30% of prostate cancers detected by PSA screening programs show Gleason scores of 6 or lower and, thus, are not poorly differentiated and have volumes smaller than 0.5 cm3.

Histologic evaluation of radical prostatectomy specimens demonstrated that about 20% to 30% of cancers are small volume, show low Gleason scores, and are consequently clinically harmless., Many of these cancers pose little threat to life, especially for older men. Has PSA screening resulted in prostate cancer overdiagnosis?

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Your Cancer Treatment Goals

Your cancer treatment goals depend on many factors. For example, the type of cancer and whether it has spread will factor into your goals.

Treatment goals include:

  • Living longer, even with cancer

  • Having fewer symptoms from cancer and side effects from its treatment

  • Maintaining physical and emotional strength

  • Having a certain quality of life

Your goals might be different from a younger persons. For example, a healthy younger person’s goal might be to cure the cancer even if treatment is very difficult. Some people are able to have aggressive treatment. This might not be true for you.

Depending on your age and general health, you might care more about feeling well than curing cancer permanently. This might be especially true if you have a chronic health condition or you feel that your quality of life is poor.

But if you are very healthy and enjoy many activities, you might want aggressive treatment. You might have plans many years in the future. If so, you might want your health care team to do everything possible for a cure.

Addition Of Other Therapies In The Hormone

Treating benign prostatic hyperplasia (BPH) with maca

Docetaxel

As in many other malignancies, we have learned that combination therapy at the outset of treatment improves long-term disease control and survival outcomes. Both docetaxel and abiraterone acetate in the hormone-sensitive setting have demonstrated a survival benefit when added to standard ADT . Based on these data, most providers should offer, or at least consider, additional therapies to treat patients at this stage. Certainly in a frail patient population, one must continue to assess the overall fitness of a patient. Any patient already thought of as fit should be offered unaltered therapy. Those found to be vulnerable or frail could be considered based on the ability to reverse at-risk conditions.

Abiraterone acetate and prednisone

The patients enrolled in the LATITUDE and STAMPEDE-abiraterone trials were generally older , with ECOG scores of 02 compared with the CHAARTED and STAMPEDE-chemotherapy cohorts. Of note, patients being treated with abiraterone must take a low-dose corticosteroid to avoid mineralocorticoid excess, which results from alteration of adrenal function. In addition, patients may not have the means to pay for this costly agent, since older patients usually have a fixed income. Overall, there is little need for dose interruptions or reductions of abiraterone, and it should be considered for a broad group of older patients with newly diagnosed metastatic hormone-sensitive prostate cancer.

Recommended Reading: How Can I Improve My Prostate Health

Watchful Waiting And Active Surveillance

Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.

Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.

Management Of Metastatic Prostate Cancer In Frail/elderly Patients

Elizabeth R. Kessler, MDOncology

In this article, we discuss the importance of assessing frail and elderly prostate cancer patients before starting treatment and making adjustments to the choice of therapy, or supportive services, in order to maximize benefit and minimize potential harms.

As the world population ages, we can expect to care for an increasing number of older cancer patients. Prostate cancer is inherently a condition that affects patients of advanced age. In caring for these patients who have advanced prostate cancer, it is important to first assess the health status of the patient and his goals of care. As this is established, likely through a geriatric assessment, this will inform how to modify or mold the treatment plan to fit a patients needs and vulnerabilities. These vulnerabilities may surface as patients undergo treatment such as androgen deprivation therapy-the backbone of systemic therapy for advanced disease. Androgen deprivation therapy leads to long-term adverse effects therefore, providers should carefully consider its use and proactively manage toxicity. It is important to assess patients before starting treatment and to adjust the choice of therapy, or supportive services, in order to maximize benefit and minimize potential harms.

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Defining Patient Subgroups By Health Status

The SIOG Prostate Cancer Working Group reviewed recent literature and opinion on prognostic factors that might affect health status, overall survival, and prostate cancer-specific survival . The most important factors to consider for the evaluation of health status in older men with prostate cancer were comorbidities, dependence status, and nutritional status.

Deaths From Prostate Cancer

Who Are Candidates for Adjuvant Therapy in Prostate Cancer? | Ask a Prostate Expert, Mark Scholz, MD

Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 41 will die of prostate cancer.

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 3.1 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA . SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

American Cancer Society. Facts & Figures 2021. American Cancer Society. Atlanta, Ga. 2021.

National Cancer Institute. SEER Cancer Stat Facts: Prostate Cancer. Accessed at https://seer.cancer.gov/statfacts/html/prost.html on March 15, 2019.

Last Revised: January 12, 2021

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Year Old With Prostate Cancer Chemo Or Not

I am an 80 year ols male. Been on active surveillance for several years with Prostate cancer. In Jan 17 my 6 monthly PSA result came back at 15 . Gleason score measured in 2015 at 6

Was immediately put on hormone treatment and had a full body scan which showed two spots outside the prostate. One on the spine and on on a lymph gland. Have just finished 20 sessions of RT and latest PSA is 0.235. So what now.

Have been told I can’t have Abiratone added to the hormone treatment because it has not been approved. I must have had chemo first. May be approved in 6 months time.

My problem is – As the hormone treatment is working well at the moment, should I wait for Abiratone to be approved or should I put myself thro chemo. I am very fit at the moment but my liver, heart etc are all 80 years old.

What will chemo add to my life expectancy, how do I balance quality of life against a few extra months.

Oh for a crystal ball. Any 80 year olds out there who have been thro this.

How To Make The Right Treatment Decision

Current expert guidelines for treatment of localized prostate carcinoma recommend potentially curative therapy for patients whose life expectancy is at least 10 years., Patients with limited life expectancy are more likely to die from health conditions other than prostate cancer. Men with a life expectancy of more than 10 years are more likely to die from progressive prostate cancer. This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.,

Conservative management proved to be an acceptable treatment option for men with low-grade Gleason scores, clinically localized disease, and life expectancies of less than 10 years. Increasing age was described as a risk factor for receiving inadequate treatment for prostate cancer. Thus, older men have been shown to receive potentially curative therapy less often than younger men., Radical prostatectomy is preferred treatment in men younger than 70 years, whereas radiation therapy is applied predominantly in patients older than 70 years. Conservative therapy such as watchful waiting or androgen deprivation by luteinizing hormone-releasing hormone analogs is preferentially applied in men older than 80 years. Watchful waiting or hormonal therapy is used to treat 82% of men older than 80 years.

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What Are The Symptoms Of Prostate Cancer

Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:

  • Frequent, sometimes urgent, need to urinate, especially at night.
  • Weak urine flow or flow that starts and stops.
  • Painful urination .
  • Painful ejaculation and erectile dysfunction .
  • Blood in semen or urine.
  • Lower back pain, hip pain and chest pain.
  • Leg or feet numbness.

Cancer Treatment Options For Older Adults

Clinical Stage T1c Prostate Cancer: Evaluation with Endorectal MR ...

You may have just one type of treatment or a combination of treatments. The main cancer treatments for people of all ages are:

  • Surgery

  • Radiation therapy

How cancer surgery can affect older adults

Like other treatments, surgery has risks. The risks can be higher when you are older because your body does not always work as well as it did. Before surgery, you and your doctor should think about the following:

Heart function. Surgery may make heart problems worse. It is important to consider your heart function before you have surgery. Older adults have heart disease or an irregular heartbeat more often than younger people. Also, your heart might not tolerate changes in blood pressure as well. This can happen during surgery.

Kidney function. Surgery can involve many drugs. You might also get a lot of fluids to keep your body working. Your kidneys need to process the drugs and fluids. If your kidneys do not work as well as they used to, surgery can cause problems.

Liver function. As you get older, less blood flows to your liver to help it work. Your liver breaks down drugs. If it does not work as well as it should, you are more likely to have a reaction to the drugs needed for surgery.

Considering surgery risks and benefits

It is important to talk with your health care team about the risks and benefits of cancer surgery. If surgery is risky for you, talk about other treatments.

Learn more about cancer surgery.

Planning for after surgery

How chemotherapy can affect older adults

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Brca1 Or Brca2 Gene Changes

You might hear your doctor call these mutations. Youâre born with them, so they fall in the category of risk factors you canât control. They run in families, but they only affect a small number of people. They raise the odds of breast and ovarian cancers in women and prostate cancer in some men.

Risk Of Prostate Cancer

About 1 man in 8 will be diagnosed with prostate cancer during his lifetime.

Prostate cancer is more likely to develop in older men and in non-Hispanic Black men. About 6 cases in 10 are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age of men at diagnosis is about 66.

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Expert Panel Recommendations For Advanced Prostate Cancer

  • ADT is the first-line treatment in hormone-sensitive metastatic prostate cancer. Evaluation of bone mineral status and prevention of osteoporosis are recommended.
  • In metastatic CRPC, chemotherapy with docetaxel is the standard for fit and vulnerable older men.
  • The tolerability of the docetaxel 3-weekly regimen has not been specifically studied in frail older men. The place of weekly docetaxel in metastatic CRPC should be further evaluated.
  • Palliative treatments include palliative surgery, radiopharmaceuticals, RT and medical treatments for pain and symptoms.

What Are The Stages Of Prostate Cancer

Older Men and Prostate Cancer – Gulfstream Urology

Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:

  • Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
  • Adds together the two most common grades to get your Gleason score .
  • Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.

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Metabolic And Body Composition

Patients may experience changes in metabolic parameters and body composition, such as bone mineral density loss and sarcopenic obesity. These changes occur naturally through the aging process and are accelerated with the use of ADT. The risk of osteoporosis development is important to keep in mind because geriatric syndromes can predispose patients to osteoporotic fractures. Men who suffer an osteoporotic fracture have a higher mortality risk compared with women. As such, preventing bone mineral density loss may in turn prevent a fracture and the associated morbidity and mortality risk of such an event. In order to modify this risk, all patients on ADT should take a daily vitamin D and calcium supplement and engage in weight-bearing exercise.

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