Skip to main content
SpringerLink
Log in

Management des Prostatakarzinoms in hohem Alter

Management of prostate cancer in the elderly

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Das Management des Prostatakarzinoms im hohen Alter wird kontrovers diskutiert. Die aktuellen Leitlinien empfehlen eine Diagnostik und Therapie des Prostatakarzinoms nur bei Patienten mit einer Lebenserwartung von > 10 Jahren. Hierbei spielen insbesondere im Alter die Komorbiditäten des Patienten eine entscheidende Rolle. Im klinischen Alltag beeinflusst jedoch oftmals alleine das tatsächliche Alter des Patienten die Therapieentscheidung. Eine leitlinienbasierte Therapie des Prostatakarzinoms sollte jedoch auch älteren Patienten angeboten werden. Die Therapieentscheidung orientiert sich hierbei zum einen am Gesundheitszustand des Patienten sowie am onkologischen Risiko. Die Einordnung des individuellen Gesundheitszustands kann anhand der vorliegenden Komorbiditäten, des Ernährungszustands und des Performance-Status bestimmt werden. Um eine optimale Therapie auch im hohen Alter zu gewährleisten, muss die onkologische Risikostratifizierung in die differentialtherapeutischen Überlegungen mit einfließen. Das Ziel dieses Artikels ist es, eine Übersicht über die Risikostratifizierung sowie Therapieoptionen des lokalisierten und metastasierten Prostatakarzinoms im Alter zu geben.

Abstract

The management of prostate cancer in elderly patients is a topic of controversial discussion. The current guidelines recommend diagnosis and treatment of prostate cancer only in patients with a life expectancy of more than 10 years. Especially in elderly patients pre-existing comorbidities play a crucial role in life expectancy. In clinical practice mostly patient age alone is considered for the treatment decision; however, a guideline-based therapy of prostate cancer should also be offered to elderly patients. The treatment decision should be based on patient general health status and the oncological risk. The patient individual health status can be determined on the basis of comorbidities present and patient nutritional and performance status. For an optimal therapy regime the oncological risk has to be considered in treatment decisions. The aim of this article is to give an overview of risk stratification and treatment options for localized and metastatic prostate cancer in elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Albertsen PC (2008) Should men over the age of 65 years receive PSA screening? Argument against. Nature clinical practice. Urology 5:232–233

    PubMed  Google Scholar 

  2. Albertsen PC, Hanley JA, Fine J (2005) 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 293:2095–2101

    Article  PubMed  CAS  Google Scholar 

  3. Alibhai SM, Naglie G, Nam R et al (2003) Do older men benefit from curative therapy of localized prostate cancer? J Clin Oncol 21:3318–3327

    Article  PubMed  Google Scholar 

  4. Bechis SK, Carroll PR, Cooperberg MR (2011) Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 29:235–241

    Article  PubMed  Google Scholar 

  5. Begg CB, Riedel ER, Bach PB et al (2002) Variations in morbidity after radical prostatectomy. N Engl J Med 346:1138–1144

    Article  PubMed  Google Scholar 

  6. Berthold DR, Pond GR, Soban F et al (2008) Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer: updated survival in the TAX 327 study. J Clin Oncol 26:242–245

    Article  PubMed  CAS  Google Scholar 

  7. Blana A, Murat FJ, Walter B et al (2008) First analysis of the long-term results with transrectal HIFU in patients with localised prostate cancer. Eur Urol 53:1194–1201

    Article  PubMed  Google Scholar 

  8. Briganti A, Spahn M, Joniau S et al (2012) Impact of age and comorbidities on long-term survival of patients with high-risk prostate cancer treated with radical prostatectomy: a multi-institutional competing-risks analysis. Eur Urol 62:1201–1204

    Article  Google Scholar 

  9. Bubolz T, Wasson JH, Lu-Yao G et al (2001) Treatments for prostate cancer in older men: 1984–1997. Urology 58:977–982

    Article  PubMed  CAS  Google Scholar 

  10. Cowen ME, Halasyamani LK, Kattan MW (2006) Predicting life expectancy in men with clinically localized prostate cancer. J Urol 175:99–103

    Article  PubMed  Google Scholar 

  11. D’amico AV, Chen MH, Renshaw AA et al (2008) Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA 299:289–295

    Article  Google Scholar 

  12. D’amico AV, Moul J, Carroll PR et al (2003) Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol 21:2163–2172

    Article  Google Scholar 

  13. Droz J-P, Balducci L, Bolla M et al (2010) Management of prostate cancer in older men: recommendations of a working group of the International Society of Geriatric Oncology. BJU Int 106:462–469

    Article  PubMed  Google Scholar 

  14. Droz J-P, Chaladaj A (2008) Management of metastatic prostate cancer: the crucial role of geriatric assessment. BJU Int 101(Suppl 2):23–29

    Article  PubMed  Google Scholar 

  15. Droz JP, Balducci L, Bolla M et al (2010) Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol 73:68–91

    Article  PubMed  Google Scholar 

  16. Dachverband Osteologie E.V. (2009) DVO-Leitlinie 2009 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei Erwachsenen. Osteologie 18:304–328

    Google Scholar 

  17. Emmerling D Pressemitteilung vom 2. Oktober 2012 – 344/12. Lebenserwartung in Deutschland erneut gestiegen. Statistisches Bundesamt Wiesbaden. http://www.destatis.de

  18. Fitzpatrick JM (2008) Management of localized prostate cancer in senior adults: the crucial role of comorbidity. BJU Int 101(Suppl 2):16–22

    Article  PubMed  Google Scholar 

  19. Heidenreich A, Bellmunt J, Bolla M et al (2011) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 59:61–71

    Article  PubMed  Google Scholar 

  20. Heinzer H, Steuber T (2009) Prostate cancer in the elderly. Urol Oncol 27:668–672

    Article  PubMed  Google Scholar 

  21. Hoffman KE (2012) Management of older men with clinically localized prostate cancer: the significance of advanced age and comorbidity. Semin Radiat Oncol 22:284–294

    Article  PubMed  Google Scholar 

  22. Hussain M, Tangen CM, Higano CS et al (2012) Intermittent (IAD) versus continuous androgen deprivation (CAD) in hormone sensitive metastatic prostate cancer (HSM1PC) patients (pts): results of S9346 (INT-0162), an international phase III trial. ASCO Meeting, Chicago, 30:4

  23. Italiano A, Ortholan C, Oudard S et al (2009) Docetaxel-based chemotherapy in elderly patients (age 75 and older) with castration-resistant prostate cancer. Eur Urol 55:1368–1375

    Article  PubMed  CAS  Google Scholar 

  24. Krebs in Deutschland 2007/2008, 8. Ausgabe. Robert-Koch-Institut, Gesellschaft der Epidemiologischen Krebsregister in Deutschland e.V. (Hrsg). Berlin

  25. Krebsgesellschaft. Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinom. AWMF-Register-Nummer (034-022OL). Version 2.0–1. Aktualisierung. http://www.krebsgesellschaft.de

  26. Lu-Yao GL, Albertsen PC, Moore DF et al (2009) Outcomes of localized prostate cancer following conservative management. JAMA 302:1202–1209

    Article  PubMed  CAS  Google Scholar 

  27. Moore CM, Robertson NL, Arsanious N et al (2012) Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 62:902–909

    Article  Google Scholar 

  28. National Comprehensive Cancer Network (2012) NCCN clinical practice guidelines in oncology: prostate cancer V.3.2012. http://www.nccn.org

  29. National Comprehensive Cancer Network (2012) NCCN clinical practice guidelines in oncology: senior adult oncology V.2.2012. http://www.nccn.org

  30. Olmi P, Ausili-Cefaro G (1997) Radiotherapy in the elderly: a multicentric prospective study on 2060 patients referred to 37 Italian radiation therapy centers. Rays 22:53–56

    PubMed  CAS  Google Scholar 

  31. Richstone L, Bianco FJ, Shah HH et al (2008) Radical prostatectomy in men aged ≥70 years: effect of age on upgrading, upstaging, and the accuracy of a preoperative nomogram. BJU Int 101:541–546

    Article  PubMed  Google Scholar 

  32. Schwartz KL, Alibhai SMH, Tomlinson G et al (2003) Continued undertreatment of older men with localized prostate cancer. Urology 62:860–865

    Article  PubMed  Google Scholar 

  33. Scosyrev E, Messing EM, Mohile S et al (2012) Prostate cancer in the elderly: frequency of advanced disease at presentation and disease-specific mortality. Cancer 118:3062–3070

    Article  PubMed  Google Scholar 

  34. Shao YH, Demissie K, Shih W et al (2009) Contemporary risk profile of prostate cancer in the United States. J Natl Cancer Inst 101:1280–1283

    Article  PubMed  Google Scholar 

  35. Stineman MG, Xie D, Pan Q et al (2012) All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage. J Am Geriatr Soc 60:485–492

    Article  PubMed  Google Scholar 

  36. Studer UE, Collette L, Whelan P et al (2008) Using PSA to guide timing of androgen deprivation in patients with T0-4 N0-2 M0 prostate cancer not suitable for local curative treatment (EORTC 30891). Eur Urol 53:941–949

    Article  PubMed  Google Scholar 

  37. Studer UE, Whelan P, Albrecht W et al (2006) Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891. J Clin Oncol 24:1868–1876

    Article  PubMed  Google Scholar 

  38. Tannock IF, De Wit R, Berry WR et al (2004) Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 351:1502–1512

    Article  PubMed  CAS  Google Scholar 

  39. Tewari A, Johnson CC, Divine G et al (2004) Long-term survival probability in men with clinically localized prostate cancer: a case-control, propensity modeling study stratified by race, age, treatment and comorbidities. J Urol 171:1513–1519

    Article  PubMed  Google Scholar 

  40. Walter LC, Covinsky KE (2001) Cancer screening in elderly patients: a framework for individualized decision making. JAMA 285:2750–2756

    Article  PubMed  CAS  Google Scholar 

  41. Whitson JM, Konety BR (2008) Should men over the age of 65 years receive PSA screening? Argument in favor. Nature clinical practice. Urology 5:230–231

    PubMed  Google Scholar 

  42. Zeliadt SB, Potosky AL, Penson DF et al (2006) Survival benefit associated with adjuvant androgen deprivation therapy combined with radiotherapy for high- and low-risk patients with nonmetastatic prostate cancer. Int J Radiat Oncol Biol Phys 66:395–402

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Urologie und Kinderurologie, Urologische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    G. Hatiboglu, B. Hadaschik, D. Teber, S. Duensing, M. Hohenfellner & S. Pahernik

Authors
  1. G. Hatiboglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Hadaschik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Teber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Duensing
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Hohenfellner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Pahernik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Hatiboglu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hatiboglu, G., Hadaschik, B., Teber, D. et al. Management des Prostatakarzinoms in hohem Alter. Urologe 52, 832–837 (2013). https://doi.org/10.1007/s00120-013-3152-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-013-3152-2

Schlüsselwörter

Keywords

Search

Navigation