Predictive Comprehensive Geriatric Assessment in elderly prostate cancer patients

Abstract

The Comprehensive Geriatric Assessment (CGA) represents the future of the geriatric oncology to reduce toxicities and treatment-related hospitalization in the elderly. Most patients receiving docetaxel for metastatic castration-resistant prostate cancer are in their seventies or older. We explored the efficacy of the CGA in predicting chemotherapy feasibility and response to docetaxel in a cohort of 24 patients aged at least 70. This was an observational, prospective study involving 24 patients who were 70 years of age or older and about to start chemotherapy with docetaxel for metastatic castration-resistant prostate cancer; we performed a CGA including five domains and divided our patients into 'healthy' and 'frail'; the relations between general condition and (i) early chemotherapy discontinuation and (ii) response to docetaxel were explored. We found a statistically significant relationship between frailty assessed by CGA and early docetaxel discontinuation; we also found an association between frailty and response to chemotherapy, but this did not reach statistical significance. A geriatric assessment before starting chemotherapy may help clinicians to recognize frail patients, and hence to reduce toxicities and early treatment discontinuation. Further analyses are required to simplify the CGA tools and to facilitate its incorporation into routine clinical practice.

The Siconolfi step test: a valid and reliable assessment of cardiopulmonary fitness in older men with prostate cancer

“…Prostate cancer is the most common cancer in UK men with almost 47,000 men diagnosed every year [1]. Higher prevalence is associated with older age and 54% of all new cases are in men aged 70 and over [1]. Poorer survival is also associated with older age, in particular for people over 70 [2].…”

“…Poorer survival is also associated with older age, in particular for people over 70 [2]. The reasons for this include multi-morbidity, which can make older men less able to tolerate treatment and its adverse effects resulting in worse adherence and non-completion [1, 2]. Furthermore, poor levels of fitness may impact negatively on clinician and patient decision-making and consequently reduce access to curative cancer treatment [3, 4].…”

Micrornas in prostate cancer: an overview

“…New therapies with established benefits on survival rate have been produced in last years [ 3 – 10 ], but nevertheless the gain in terms of survival is minimal. Prostate cancer is a very heterogeneous tumor which can show up indolent or very aggressive, usually with metastasis to other organs and bone [ 11 – 14 ], thus generating morbidity and mortality [ 15 ]. Prostate cancer can be clinically diagnosed as local or advanced and different treatments including surveillance, radiotherapy [ 16 – 18 ], radical prostatectomy and androgen-deprivation treatment are expected.…”

Management of metastatic prostate cancer in the elderly: identifying fitness for chemotherapy in the post‐STAMPEDE world

“…The International Society of Geriatric Oncology states that all patients above the age of 70 years with cancer should undergo a geriatric assessment. An observational, prospective study of men aged >70 years starting docetaxel for metastatic hormone‐resistant prostate cancer revealed that the Comprehensive Geriatric Assessment (CGA) could predict which ‘frail’ patients would discontinue chemotherapy and reached statistical significance . This is encouraging; however, the CGA is time consuming and not easily incorporated into routine clinical practice.…”