Prostate Cancer in Younger and Older Patients: Do We Treat Them Differently?

Situmorang, Gerhard Reinaldi; Umbas, Rainy; Mochtar, Chaidir Arif; Santoso, Rachmat Budi

doi:10.7314/apjcp.2012.13.9.4577

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…Surgical or medical primary androgen deprivation therapy (PADT) is another option especially in elderly population. Situmorang et al (28) reported that 39% of clinical stage I-III patients older than 75 years received PADT compared with 10% of similar stage patients with age <60 years. Another study comparing localized and locally advanced cases treated with PADT found that the mean age was 74 and 68.07 years, respectively; 5-year OS was 77.3% in localized patients in contrast to 22.7% in locally advanced cases (29).…”

Section: Prostate Cancermentioning

confidence: 99%

Urologic cancer in Indonesia

Umbas

Safriadi

Mochtar

et al. 2015

Jpn. J. Clin. Oncol.

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Non-communicable diseases, including cancer, start to become more common in Indonesia. According to the government statement, incidence of malignant diseases increased annually up to 8% in the last decade and these diseases become the seventh leading cause of death in Indonesia. On the basis of the latest Globocan report on cancer incidence in Indonesia, prostate cancer ranks sixth; followed by bladder (12th) and kidney (18th). More than half of patients with kidney cancer are diagnosed in the advanced stage. Besides renal cell carcinoma, there are significant number of people affected with squamous cell and transitional cell carcinoma because of kidney stones. Radical nephrectomy or cytoreductive nephrectomy was the primary treatment, mostly done as an open procedure. Transitional cell carcinoma is the commonest histology type in bladder cancer cases followed by squamous cell carcinoma, which almost always related to bladder stones. Unfortunately, >70% of our cases were diagnosed with muscle invasive bladder cancer, and ∼60% of these patients refused further radical treatment. Incidence of prostate cancer is increasing rapidly and it becomes the third most common cancer in men. However, most of our patients are diagnosed in the advanced stage. Radical prostatectomy or external beam radiotherapy is the treatment of choice in localized disease. Nearly 40% of the elderly patients are treated with primary androgen deprivation therapy. Therefore, it requires more research by the Indonesian urologists and other healthcare providers to diagnose these cancers in earlier stage as well as community education for prevention.

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Section: Prostate Cancermentioning

confidence: 99%

Urologic cancer in Indonesia

Umbas

Safriadi

Mochtar

et al. 2015

Jpn. J. Clin. Oncol.

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“…In 18 of these, consideration of contra-indications could be considered not relevant, since they examined access to generic healthcare services (for example Burge et al examined access to palliative care among cancer patients [41]). However, in eight other studies, this omission makes interpretation problematic as non-receipt may or may not have been appropriate (for example Situmorang et al examined treatment for prostate cancer [42]). Thirteen studies included measures of comorbidity within their statistical analyses, but in eight of these no clear justification for their inclusion was provided.…”

Section: Resultsmentioning

confidence: 99%

Identifying inequitable healthcare in older people: systematic review of current research practice

Salway

Payne

Rimmer

et al. 2017

Int J Equity Health

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BackgroundThere is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair.MethodA systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability.ResultsForty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were ‘inequitable’. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles.ConclusionsCaution is needed among clinicians and other evidence-users in accepting claims of healthcare ‘ageism’ in some published papers. Principles for improved research practice are proposed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0605-z) contains supplementary material, which is available to authorized users.

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“…As well the US Preventive Services Task Force (USPSTF) has recommended against routine PSA screening for prostate cancer and claimed upper limit of age as 75 in an earlier version (Moyer, 2012). However, this lack of clear guidance on this point is well reflected by the treatment practices of urologists which show a great variance (Lipinski et al, 2013;Situmorang et al, 2013;Verim et al, 2013). In our practice, PSA analysis in the elderly depends mainly on either physical examination and/or lower urinary tract symptom driven suggestion, or patient's own will as a continuum of yearly PSA screening.…”

Section: Discussionmentioning

confidence: 99%

Prostate Biopsy in the Elderly: Histologic Findings and Treatment Necessity

Akman¹,

Köseoğlu²,

Oguzulgen³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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The aim of this study is to determine results of high prostate specific antigen (PSA) or abnormal digital rectal examination driven prostate biopsies performed in our Department in men aged 75 or more and to show the characteristics of pathology results. The hospital records of the patients who had high PSA or abnormal digital rectal examination driven prostate biopsy in two common university based research hospitals have been reviewed retrospectively. Patients aged 75 years or older at the date of biopsy whose records provided pathology results and full medical history were evaluated for the study. A total of 103 patients were evaluated with a mean age of 79.4 ±3.4 years. More than half of the patients (55.1%) were in their seventh decade and the rest were in the eighth decade. Median PSA value was 15.0 (range 2.1-4500) ng/ml. In most of the biopsies (67%), PSA levels were lower than 20 ng/ml. In almost half of the patients (48%), digital rectal examination was abnormal. In 68.9% of the patients, there were at least one or more associated co-morbid diseases. Gleason scores were 7 or higher in 73%, and 8 or higher in 37% of the patients with prostate cancer. Four of the 70 (6%) patients had bone metastases. Castrations were applied to most of the patients with prostate adenocarcinoma (%79). High percentage of high grade (Gleason 7 or more) prostate adenocarcinoma in the elderly refutes the perception of prostate cancer in this age group as clinically insignificant. Therefore, it is to be kept in mind that prostate cancer in the elderly an be clinically significant and prostate biopsies are to be performed when necessary.

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Prostate Cancer in Younger and Older Patients: Do We Treat Them Differently?

Cited by 10 publications

References 13 publications

Urologic cancer in Indonesia

Urologic cancer in Indonesia

Identifying inequitable healthcare in older people: systematic review of current research practice

Prostate Biopsy in the Elderly: Histologic Findings and Treatment Necessity

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