From the Guidelines
For men over 80 years old with prostate cancer, a conservative approach focusing on quality of life is typically recommended, with active surveillance being a viable option for low-risk disease, as stated in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up 1. When considering treatment options, it's essential to take into account comorbidities and impaired renal function. The guidelines suggest that patients with intermediate-risk disease should be staged for metastases using MRI or CT (abdomen and pelvis) and bone scan 1. Some key points to consider in treatment decisions include:
- Active surveillance is a strategy of close monitoring, typically using PSA, repeat biopsies, and MRI, keeping curative treatment for those with evidence of disease progression 1.
- Curative options include radical prostatectomy (RP), external beam radiotherapy (RT), and low-dose-rate brachytherapy, but these may not be suitable for men over 80 years old due to increased surgical risks and limited life expectancy benefit 1.
- Androgen deprivation therapy (ADT) is commonly used when treatment is necessary, with medications such as leuprolide, bicalutamide, or goserelin, but side effects like hot flashes, fatigue, loss of muscle mass, and increased cardiovascular risk must be monitored and managed appropriately 1.
- Radiation therapy may be appropriate for localized disease, typically delivered in 20-28 sessions over 4-6 weeks, but the decision to use radiation therapy should be made on a case-by-case basis, considering the patient's overall health status and comorbidities 1.
- Chemotherapy with docetaxel may be considered for metastatic disease that no longer responds to hormonal therapy, but this should be weighed against the potential benefits and risks, including side effects and impact on quality of life 1. Ultimately, treatment decisions should prioritize quality of life, considering the patient's overall health status, comorbidities, and personal preferences, as well as the potential benefits and risks of each treatment option 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Prostate Cancer in Men Over 80 Years Old
- The management of prostate cancer in men over 80 years old should be based on individual health status, considering comorbidities and impaired renal function 2, 3.
- Treatment options include watchful waiting, surgery, radiation therapy, hormone therapy, and chemotherapy, with the choice of treatment depending on the patient's overall health and the stage of the cancer 4, 5.
- For men with high-risk prostate cancer, definitive local therapy, including surgery or radiation therapy with or without androgen deprivation therapy, is associated with improved overall survival compared to observation or androgen deprivation therapy alone 6.
Consideration of Comorbidities and Impaired Renal Function
- Comorbidities and impaired renal function should be taken into account when deciding on treatment options for prostate cancer in men over 80 years old 2, 3.
- Patients with severe comorbidities or impaired renal function may require adapted treatment, such as watchful waiting or palliative care 2, 3.
- A comprehensive geriatric assessment should be performed to evaluate the patient's health status and determine the most appropriate treatment approach 3.
Treatment Patterns and Outcomes
- Treatment patterns for prostate cancer in men over 80 years old vary, with some patients receiving observation, androgen deprivation therapy, radiation therapy, or surgery 6.
- Overall survival outcomes are improved with definitive local therapy, including surgery or radiation therapy with or without androgen deprivation therapy, compared to observation or androgen deprivation therapy alone 6.
- Life expectancy, rather than chronological age, should be taken into account when deciding on treatment options for prostate cancer in men over 80 years old 6.