The authors aimed to identify the recommended treatments for prostate cancer in men over the age of 70 years.

The authors concluded that treatments for local and advanced prostate cancer in elderly men should be individualized, with focus on the health of the patient, to determine the appropriate treatment course.

Prostate cancer often occurs in elderly men over the age of 70 years, and therefore, treatment needs to be appropriate for the individual patient, based on fitness and health. It is also important to take mental capacity into consideration, to ensure that patients are capable of making informed decisions regarding their treatment. Elderly men who are healthy and fit should be offered any form of standard treatment available, whereas men who have deteriorating health or mental status need to be more carefully considered. Treatments can include prostate surgery (removal of the prostate gland), radiation therapy (directing a beam of radiation at the tumor site) and hormone therapy (targets the male sex hormones active in prostate cancer, such as testosterone).

The International Society of Geriatric Oncology gathered a panel of experts to update 2014 guidelines for the treatment of prostate cancer in elderly men.

The aim of this study was to determine the best treatment options available for men over the age of 70 years with prostate cancer. 

Patients with very low-risk disease may benefit from active surveillance (no active treatment, but careful watching for disease progression).

Elderly men are more likely to have larger and more advanced cancer. Prostate surgery in these patients has shown a 91% survival rate after surgery when combined with follow-up treatments. Survival can reach 95% in men that only have one risk factor (more advanced tumor stage, elevated prostate specific antigen levels [PSA – protein elevated in the blood when cancer is present] etc). This is compared to 79% in men with three or more risk factors. Reports show that more than 86% of elderly men regain continence after prostate surgery.

Hormone therapy in patients too frail to receive more active treatments has shown an improved overall survival (patients who were still alive after treatment) of 79%. Radiation therapy combined with hormone therapy is standard for locally advanced prostate cancer. This combination has been shown to reduce local cancer growth and improve survival, even after 6-7 years. However, hormone therapy increases the risk of fractures, mental impairment, diabetes and heart disease.

In elderly men with advanced prostate cancer that has spread beyond the prostate, hormone therapy combined with the chemotherapy docetaxel (Taxotere) improves 4-year survival by 9%. It also improves 4-year treatment failure rates by 16%. Chemotherapy treatment with docetaxel and prednisone shows the same treatment success rates in elderly patients as it does in younger patients. Elderly men treated with abiraterone (Zytiga) and prednisone experienced a significantly longer overall survival than patients treated with prednisone and placebo (substance with no active effect).

This article offered guidelines for the treatment of older prostate cancer patients. The authors concluded that treatments for local and advanced prostate cancer in elderly men should be individualized, with focus on the health of the patient, to determine the appropriate treatment course.