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Prostate Cancer In Elderly Men

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The Top 7 Signs Of Advanced Prostate Cancer

Older Men and Prostate Cancer

In the early stages, you may not notice any symptoms related to prostate cancer. This is why screenings are important. Symptoms can sometimes be noticed for the first time when the cancer advances.

Advanced prostate cancer, also called metastatic cancer, means the cancer has spread to other areas of your body beyond your prostate gland. The most common areas for prostate cancer to spread are your bladder, rectum, and bones. It can also spread to your lymph nodes, liver, lungs, and other body tissues.

Whether youve just been diagnosed or youre in treatment, its also important to know the signs of advanced cancer. Cancer can behave differently depending on your genetics, so not every person will experience the same symptoms in the same way.

Read on to learn more about the seven top symptoms of advanced prostate cancer and how to spot them.

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Prostate Cancer In Older People

With the exception of skin cancer, prostate cancer is the most common type of cancer in men in the U.S. In 2022, nearly 270,000 men will be diagnosed with prostate cancer, the American Cancer Society estimates.

The average age of diagnosis is 66. But as you get older, your chances of developing the disease go up. The questions of whether to screen for prostate cancer and whether to treat it become more complicated with age. And, if youâre older, the disease can be more deadly.

According to guidelines from the American Society of Clinical Oncologists, prostate cancer is more than twice as likely in people over 70 than in younger people. Theyâre also more than four times as likely to have advanced prostate cancer. And theyâre more likely to die from the disease.

But keep in mind that age is just a number. While the risk goes up with each birthday, thereâs no particular age at which prostate cancer becomes most dangerous. When you and your doctor discuss diagnosis and treatment options, the focus should not only be on your chronologic age — the number of years youâve been alive — but on whatâs called your biologic age.

Biologic age means, basically, how healthy you are now based on factors like your genes, lifestyle, and environment. Are you fit and otherwise healthy? Or do you have other illnesses that affect your overall health? This can help predict how long youâll live in good health.

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.

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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.12,14 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.14 This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.15,16

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.17 Thus, older men have been shown to receive potentially curative therapy less often than younger men.18,19 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.

Expert Panel Recommendations For Localized Prostate Cancer

Sick Senior Old Man With Prostate Cancer Prostate Inflammation ...

Treatment decisions should be based on a health status evaluation rather than chronological age, and on patient preference.

Fit and vulnerable older men in the high-risk group defined by DAmico et al. , with a chance of surviving for > 10 years are likely to benefit from curative treatment.

Older men in the low-risk and possibly in the intermediate-risk groups of the risk classification are likely to benefit from an active surveillance approach.

The benefits and harms of ADT for localized prostate cancer should be carefully balanced in older men. Attention is drawn to an increased risk of diabetes, cardiovascular complications, and osteoporosis and bone fractures.

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Impact Of Age On Treatment

The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests.10 Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.11,12

Chodak and associates12 evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.

Should You Get Treatment For Prostate Cancer

When you get a prostate cancer diagnosis, you have several options. You can get various types of treatment for your cancer, including hormone deprivation therapy, surgery, or radiation. Or you can go without it, at least at first.

Not everyone whoâs diagnosed with prostate cancer will go on to develop symptoms that affect their lives. Due to screening tests, early diagnosis is common. But prostate cancer may not progress for years after youâre diagnosed.

If youâre at higher risk of dying from something other than prostate cancer, your doctor will likely recommend watchful waiting. That means theyâll address bothersome symptoms if and when they occur. The goal is to keep you comfortable and increase your quality of life, rather than to try to stop the disease itself.

If youâre younger and have a low-risk prostate cancer, your doctor may recommend active surveillance. As with watchful waiting, you wonât get immediate treatment. But you will have regular tests to be sure your cancer continues to grow slowly. If it does become aggressive, treatment may begin.

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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.

Cancer Treatment Options For Older Adults

10 Warning Signs of Prostate Cancer

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

  • 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

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What Are The Stages Of Prostate Cancer

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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Prostate Cancer: A Guide For Aging Men

Prostate cancer is one of the most frequently diagnosed cancers in the world, despite it only being diagnosed in males . In fact, more than 70 percent of men over the age of 80 have some quantity of cancer cells in their prostate.

Its so common that it sometimes doesnt go diagnosed until autopsies are performed, though that doesnt mean the cancer is the cause of death. On the contrary, the overall prognosis for men diagnosed with prostate cancer is as positive as you can get when talking about the dreaded c word. The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.

The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.

Nevertheless, prostate cancer is serious business, and the best way to handle a diagnosis is to be informed. Lets take a look at the frequency at which its diagnosed, how youre tested for it, how it can affect your daily life, and what we can do to try and prevent the disease.

Average Age of Prostate Cancer Diagnosis

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What Should I Look For

Regardless of age, prostate cancer often starts without warning signs until it has advanced further. This is why it is important to engage in appropriate screenings and talk with your provider regularly about your risk. When prostate cancer manifests, early symptoms include changes in urination, such as increased urgency and frequency of urination, blood in the urine or semen, interrupted or changed flow of urine stream, painful urination, erectile dysfunction, and pain in the pelvis, hips, thighs or lower back.

Prostate Cancer In The Elderly: Frequency Of Advanced Disease At Presentation And Disease

Elderly Man Receiving Radiotherapy Treatments For Prostate Cancer Stock ...

Scosyrev E, Messing EM, Mohile S, et al.Cancer. 2012 118:30623070 .

Scosyrev and colleagues used the Surveillance, Epidemiology, and End Results database to determine the frequency of metastatic disease and prostate cancer death in different age groups. A total of 464,918 patients diagnosed with prostate cancer between 1998 and 2007 were categorized into 10 age groups ranging from < 50 years to 90 years. The largest group was aged 65 to 69 years .

Information on comorbidities was not included in the analysis. Tumor features, including Gleason score and stage at presentation were recorded, and men were followed for a median of 4.5 years . Expected survival was obtained from the general population, and the Gray method was used to assess the cumulative incidence of death from prostate cancer in different age groups. The frequency of metastatic prostate cancer ranged from 3% to 17% . Overall, men aged > 75 years represented 52% of all M1 cases.

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Deaths From Prostate Cancer

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

What Causes Prostate Cancer

Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:

  • Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
  • Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.

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Prostate Cancer In Elderly Men

Prostate cancer is a common type of cancer among American men. It is most common among African American men. Treatment for prostate cancer works best when the disease is found early.

Early prostate cancer does not usually cause symptoms. As the cancer grows, it may cause trouble urinating. Also, your elderly father may need to urinate often, especially at night. Other symptoms can be pain or burning during urination, blood in the urine or semen, pain in the back, hips, or pelvis, and painful ejaculation.

To figure out if these symptoms are caused by prostate cancer, your doctor will ask your aging dad questions about his past medical problems. He or she will perform a physical exam. In the exam, the doctor will put a gloved finger into your father’s rectum to feel the prostate through the wall of the rectum. Hard or lumpy areas may be a sign of cancer.

Your doctor may also do a test to check the prostate-specific antigen level in your dad’s blood. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer. Your elderly father may also need to have an ultrasound exam. In this procedure, a probe that produces sound waves is put into the rectum. Sound waves bounce off the tissues, and a computer uses the echoes to make a picture of the prostate.

What Is The Prognosis For People Who Have Prostate Cancer

Managing Prostate Cancer in Elderly/Unfit Patients

Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.

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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.

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 canât 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 â 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.

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