Tuesday, November 29, 2022

Prostate Cancer In Old Age

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Addition Of Other Therapies In The Hormone

Prostate Cancer: Common Cancer for Men in Their 50s and Older

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.

Symptoms Of Prostate Carcinoma

The screening for prostate carcinoma is very simple and widely available: it involves determining the levels of a marker called PSA in blood. The cutoff values of PSA vary with age high levels indicate a possible prostate neoplasm and require further investigation. With the help of screening, prostate cancer can sometimes be discovered before it gives any symptoms.

Early symptoms of prostate cancer are lower urinary tract symptoms, which are generally common in older men, often due to a harmless condition called benign prostatic hyperplasia . These symptoms include:

  • Urination difficulties: straining to urinate, poor and/or intermittent stream, dripping at the end of urination
  • Frequent urination and urination during the night, often accompanied by an urgent need to urinate and/or incontinence
  • Feeling of incomplete emptying after urination.

Early prostate cancer may also be presented with:

Symptoms of advanced disease are symptoms of the disease spreading to other tissues and organs:

  • Tingling, leg weakness or paralysis, pain, urinary or fecal incontinence, due to a compression of the spinal cord
  • Severe bone pain, due to metastases, particularly common in the vertebrae, hips, pelvis, and ribs
  • Leg swelling, due to cancer spreading to pelvic lymph nodes
  • Fatigue and/or loss of weight.

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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Treating Advanced Prostate Cancer

If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

  • hormone treatment

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

Are Older Men Undertreated

Prostate cancer by age, 2010

Schwartz and colleagues44 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 colleagues46 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.

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What Are The Survival Rates

Many factors contribute to an individuals prostate cancer prognosis including age, clinical stage, grade, comorbidities, PSA level, and response to treatment. Prostate cancer has incredibly high survival rates at the five, ten, and fifteen-year marks, and this is no exception when it comes to men of older age. Survival rates tend to decline very slightly for men roughly 85 and older, but this could also be due to potential life-shortening comorbidities. In fact, young men with aggressive prostate cancer are more likely than their older counterparts to experience prostate-cancer mortality, since many older men may have many other factors that contribute to mortality that come along with the natural aging process.

Prostate Cancer Survival By Age

Five-year survival for prostate cancer shows an unusual pattern with age: survival gradually increases from 91% in men aged 15-49 and peaks at 94% in 60-69 year olds survival falls thereafter, reaching its lowest point of 66% in 80-99 year olds patients diagnosed with prostate cancer in England during 2009-2013. The higher survival in men in their sixties is likely to be associated with higher rates of PSA testing in this age group.

Prostate Cancer , Five-Year Net Survival by Age, Men, England, 2009-2013

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Cancer Incidence And Death Rates By Sex And World Region

Worldwide, the incidence rate for all cancers combined was 19% higher in men than in women in 2020, although rates varied widely across regions. Among men, incidence rates ranged almost 5-fold, from 494.2 per 100,000 in Australia/New Zealand to 100.6 per 100,000 in Western Africa among women, rates varied nearly 4-fold, from 405.2 per 100,000 in Australia/New Zealand to 102.5 per 100,000 in South Central Asia. These variations largely reflect differences in exposure to risk factors and associated cancers and barriers to high-quality cancer prevention and early detection. For example, the highest overall incidence rates in Australia/New Zealand are caused in part by an elevated risk of NMSC because most of the population is light-skinned, and excessive sun exposure is prevalent, in conjunction with increased detection of the disease.

The gender gap for overall cancer mortality worldwide is twice that for incidence, with death rates 43% higher in men than in women , partly because of differences in the distribution of the cancer types. Death rates per 100,000 persons varied from 165.6 per 100,000 in Eastern Europe to 70.2 per 100,000 in Central America among men and from 118.3 per 100,000 in Melanesia to 63.1 per 100,000 in Central America and South Central Asia among women. Notably, the cumulative risk of dying from cancer among women in 2020 was higher in Eastern Africa than in Northern America , Western Europe , and Australia/New Zealand .

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Prostate Cancer: A Guide For Aging Men

Prostate Cancer Screening Age – Penn State Cancer Institute 4A

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.

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.

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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.

Assessment At Study Entry

One hundred patients presenting with intermediate or high-risk prostate cancer were recruited in 11 different cancer centers . Their median age was 77.5 years . The median distance between the patients home and radiotherapy center was 28 km . The ADT was administered in 50% of patients. Severely or moderately impaired urinary function was observed in 11.2% and 44.9% of patients respectively. Among 78 patients who responded to the IIEF questionnaire which assesses sexual activity and erectile function, sexual activity was present in 26 patients , among whom eight experienced normality or only minor dysfunction , nine moderate dysfunction , and nine severe dysfunction . The CIRS-G revealed comorbidity in 66/100 patients, with 51/100 of patients presenting moderate to severe cardiovascular comorbidities. A GDS score 1 revealed depressive symptoms in 31/100 of patients. The activities of daily life and Instrumental Activities of Daily Life were impaired in 16/100 and 51/100 of patients respectively. Cognitive disorders were revealed in 20/100 of patients. The calculated risk of fall was 8/100 and undernutrition was found in 2/100 of patients.

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Is Prostate Cancer Different In Older Vs Younger Men

A recent review in the Lancetof five main cancer types concluded that yes, it is, and this needs to be better understood to develop more personalised care to patients.

To conclude, although most tumour subtypes and molecular alterations seem to be present in all age categories, there are clear shifts in the distribution of these characteristics with increasing age. The biological explanation as to why some subtypes and alternations are more frequent in older people has yet to be elucidated. Cumulative DNA damage with increasing age and immunosenescence might play a role, but are insufficient to explain all the observations summarised in this Review. A better understanding of these biological processes is needed and might help to better understand cancer biology globally, and as such improve personalised cancer care in both young and old people with cancer.

Cancer Incidence And Mortality Patterns By The 4

Prostate Cancer Elder Alert

Incidence rates increased with increasing HDI level, ranging from 104.3 and 128.0 per 100,000 in low HDI countries to 335.3 and 267.6 per 100,000 in very high HDI countries for men and women, respectively . Mortality rates are about 2-fold higher in higher HDI countries versus lower HDI countries in men, whereas little variation exists across HDI levels in women .

  • a Incidence excludes basal cell carcinoma, whereas mortality includes all types of nonmelanoma skin cancer.
  • Abbreviation: HDI, Human Development Index.

Figures and show cancer incidence and mortality ASRs in higher HDI versus lower HDI countries for men and women, respectively, in 2020. For incidence in men , lung cancer ranks first and prostate cancer ranks second in higher HDI countries, and vice versa for lower HDI countries . These cancers were followed by colorectal cancer in higher HDI countries, largely reflecting the substantial contribution by the United States, and lip and oral cavity cancer in lower HDI countries because of the high burden of the disease in India. In women , incidence rates for breast cancer far exceed those of other cancers in both transitioned and transitioning countries, followed by colorectal cancer in transitioned countries and cervical cancer in transitioning countries.

Figure 7

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How Common Is Prostate Cancer In Older Men

Only 10 percent of prostate cancer cases are considered early-onset and occur before the age of 55 years old. The remaining 90 percent of cases occur in men older than this, and prostate cancer is considered the most common malignancy in the elderly population. It has even been estimated that roughly half of all men between 70 and 80 years old have microscopic evidence of the condition. The number of older men being diagnosed with prostate cancer is rising however, likely due to screening methods like the prostate-specific antigen test, and a larger proportion of individuals being screened, as well as an increase in the life expectancy of the general population.

It has been estimated that by 2050, the percentage of individuals older than age 65 will increase four times in comparison to the year 2000. With a greater proportion of older individuals in the world, comes a greater amount of older men who can develop prostate cancer. For this reason, much research is ongoing to determine the best ways to treat men with prostate cancer of varying ages, including the elderly.1-3

Cancer Treatment Options For Older Adults

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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Can I Check My Own Prostate

It is not recommended that you try to check your own prostate.

The prostate is an internal gland, and performing a self-examination could cause harm. For your safety, the exam should be performed by a licensed healthcare professional.

Additionally, a professional will be better able to assess if there is a reason for concern.

What Are The Stages Of Prostate Cancer

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Cancer staging is first described using what is called a TNM system. The T refers to a description of the size or extent of the primary, or original, tumor. N describes the presence or absence of, and extent of spread of the cancer to lymph nodes that may be nearby or further from the original tumor. M describes the presence or absence of metastases usually distant areas elsewhere in the body other than regional lymph nodes to which the cancer has spread. Cancers with specific TNM characteristics are then grouped into stages, and the stages are then assigned Roman numerals with the numerals used in increasing order as the extent of the cancer being staged increases or the cancer prognosis worsens. Prognosis is finally reflected by considering the patients PSA score at presentation as well as their Gleason score in assigning a final stage designation.

The American Joint Commission on Cancer system for prostate cancer staging is as follows:

Traditionally, advanced prostate cancer was defined as disease that had widely metastasized beyond the prostate, the surrounding tissue, and the pelvic lymph nodes and was incurable. However, a more contemporary definition includes patients with lower grade disease with an increased risk of progression and/or death from prostate cancer in addition to those with widely metastatic disease.

The National Cancer Institute and the National Comprehensive Cancer Network guidelines on prostate cancer version 2.2017 indicate the following:

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Which Age Groups Have The Highest Incidence Of Prostate Cancer

Prostate cancer incidence increases as men age as many as 60% of men over 65 years of age may be diagnosed with prostate cancer. Prostate cancer is most often diagnosed in men aged 65-74 years median age at diagnosis is 66 years.

However, men as young as 17 years are experiencing an increasing incidence of prostate cancer in much of the world, including the United States, according to data from the Surveillance, Epidemiology, and End Results program and the Institute for Health Metrics and Evaluation Global Burden of Disease database. These younger patients frequently present with more advanced cancer and have worse survival than middle-aged and older men. Worldwide, the incidence of prostate cancer has increased in men ages 15 to 40 years at a steady rate averaging 2% per year since 1990. In the United States, this age group was more than 6 times more likely than older men to have distant disease at diagnosis.

References
  • Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov. 68 :394-424. .

  • American Cancer Society. Cancer Facts & Figures 2021. Available at . Accessed: February 2, 2021.

  • Komyakov BK, Sergeev AV, Fadeev VA, et al. . Urologiia. 2017 Sep. 42-5. .

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