Skip to main content
SpringerLink
Log in

Clinical Management of Elderly Patients’ Metastatic Prostate Cancer: Other Treatments and Supportive Care

  • Chapter
  • First Online:
Management of Urological Cancers in Older People

Part of the book series: Management of Cancer in Older People ((volume 1))

  • 693 Accesses

Abstract

Prostate cancer is a frequent disease, especially in elderly men. Treatment of metastatic prostate cancer is palliative at any age. It requires a global oncological approach with the input of several teams: urologists, medical oncologists, radiotherapists, other surgeons etc. Hormone deprivation is the main treatment for hormone-sensitive metastatic disease. Chemotherapy is the standard treatment for metastatic castration-resistant disease, but new drugs, mainly new hormonal treatments, are being developed. Other treatment modalities can be used to treat patients in these situations, such as bone-targeted agents, radiopharmaceutics etc. Evolution of the disease is variable, but some problems, such as pain, fractures, compressions, etc., occur frequently and need a specific approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 229.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008 v1.2, cancer incidence and mortality worldwide: IARC CancerBase No. 10 [Internet]. Lyon: International Agency for Research on Cancer; 2010.

    Google Scholar 

  2. Droz JP, Balducci L, Bolla M, Emberton M, Fitzpatrick JM, Joniau S, Kattan MW, Monfardini S, Moul JW, Naeim A, van Poppel H, Saad F, Sternberg CN. Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol. 2010;73(1):68–91.

    Article  PubMed  Google Scholar 

  3. Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25(14):1824–31. Review.

    Article  PubMed  Google Scholar 

  4. Huggins C, Hodges CV. Studies on prostatic cancer. I. The effect of castration, of estrogen and of androgen injection on serum phosphatase in metastatic carcinoma of the prostate. J Urol. 2002;167(2P 2):948–51, discussion 952.

    Article  PubMed  CAS  Google Scholar 

  5. Huggins C, Stevens Jr RE, Hodges CV. Studies on prostate cancer. II. The effect of castration on advanced carcinoma of the prostate gland. Arch Surg. 1941;43:209.

    Article  CAS  Google Scholar 

  6. Mottet N, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, Schmid HP, Van der Kwast T, Wiegel T, Zattoni F, Heidenreich A. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2011;59(4):572–83.

    Article  PubMed  Google Scholar 

  7. Soloway MS, Chodak G, Vogelzang NJ, Block NL, Schellhammer PF, Smith Jr JA, Scott M, Kennealey G, Gau TC. Zoladex versus orchiectomy in treatment of advanced prostate cancer: a randomized trial. Zoladex Prostate Study Group. Urology. 1991;37(1):46–51.

    Article  PubMed  CAS  Google Scholar 

  8. Peeling WB. Phase III studies to compare goserelin (Zoladex) with orchiectomy and with diethylstilbestrol in treatment of prostatic carcinoma. Urology. 1989;33(5 Suppl):45–52.

    Article  PubMed  CAS  Google Scholar 

  9. Labrie F, Dupont A, Bélanger A, Emond J, Monfette G. Simultaneous administration of pure antiandrogens, a combination necessary for the use of luteinizing hormone-releasing hormone agonists in the treatment of prostate cancer. Proc Natl Acad Sci USA. 1984;81(12):3861–3.

    Article  PubMed  CAS  Google Scholar 

  10. Maximum androgen blockade in advanced prostate cancer: an overview of the randomised trials. Prostate Cancer Trialists’ Collaborative Group. Lancet. 2000;355(9214):1491–8.

    Google Scholar 

  11. Nair B, Wilt T, MacDonald R, Rutks I. Early versus deferred androgen suppression in the treatment of advanced prostatic cancer. Cochrane Database Syst Rev. 2002;(1):CD003506.

    Google Scholar 

  12. http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf November 2011.

  13. Taylor LG, Canfield SE, Du XL. Review of major adverse effects of androgen-deprivation therapy in men with prostate cancer. Cancer. 2009;115(11):2388–99.

    Article  PubMed  Google Scholar 

  14. Levine GN, D’Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, Milani RV, Sagalowsky AI, Smith MR, Zakai N, American Heart Association Council on Clinical Cardiology and Council on Epidemiology and Prevention, the American Cancer Society, and the American Urological Association. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. Circulation. 2010;121(6):833–40.

    Article  PubMed  Google Scholar 

  15. Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN, Oudard S, Théodore C, James ND, Turesson I, Rosenthal MA, Eisenberger MA, TAX 327 Investigators. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med. 2004;351(15):1502–12.

    Article  PubMed  CAS  Google Scholar 

  16. Fosså SD, Jacobsen AB, Ginman C, Jacobsen IN, Overn S, Iversen JR, Urnes T, Dahl AA, Veenstra M, Sandstad B. Weekly docetaxel and prednisolone versus prednisolone alone in androgen-independent prostate cancer: a randomized phase II study. Eur Urol. 2007;52(6):1691–8.

    Article  PubMed  Google Scholar 

  17. Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C, European Organisation for Research and Treatment of Cancer. 2010 Update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer. 2011;47(1):8–32.

    Article  PubMed  CAS  Google Scholar 

  18. Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L, Chin JL, Vinholes JJ, Goas JA, Chen B, Zoledronic Acid Prostate Cancer Study Group. A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst. 2002;94(19):1458–68.

    Article  PubMed  CAS  Google Scholar 

  19. Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L, Chin JL, Vinholes JJ, Goas JA, Zheng M, Zoledronic Acid Prostate Cancer Study Group. Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. J Natl Cancer Inst. 2004;96(11):879–82.

    Article  PubMed  CAS  Google Scholar 

  20. Fizazi K, Carducci M, Smith M, Damião R, Brown J, Karsh L, Milecki P, Shore N, Rader M, Wang H, Jiang Q, Tadros S, Dansey R, Goessl C. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. Lancet. 2011;377(9768):813–22.

    Article  PubMed  CAS  Google Scholar 

  21. Bauman G, Charette M, Reid R, Sathya J. Radiopharmaceuticals for the palliation of painful bone metastasis-a systemic review. Radiother Oncol. 2005;75(3):258–70. Review.

    PubMed  CAS  Google Scholar 

  22. Nilsson S, Strang P, Ginman C, Zimmermann R, Edgren M, Nordström B, Ryberg M, Kälkner KM, Westlin JE. Palliation of bone pain in prostate cancer using chemotherapy and strontium-89. A randomized phase II study. J Pain Symptom Manage. 2005;29(4):352–7.

    Article  PubMed  CAS  Google Scholar 

  23. Oosterhof GO, Roberts JT, de Reijke TM, Engelholm SA, Horenblas S, von der Maase H, Neymark N, Debois M, Collette L. Strontium(89) chloride versus palliative local field radiotherapy in patients with hormonal escaped prostate cancer: a phase III study of the European Organisation for Research and Treatment of Cancer, Genitourinary Group. Eur Urol. 2003;44(5):519–26.

    Article  PubMed  CAS  Google Scholar 

  24. Smeland S, Erikstein B, Aas M, Skovlund E, Hess SL, Fosså SD. Role of strontium-89 as adjuvant to palliative external beam radiotherapy is questionable: results of a double-blind randomized study. Int J Radiat Oncol Biol Phys. 2003;56(5):1397–404.

    Article  PubMed  Google Scholar 

  25. Pagliaro LC, Delpassand ES, Williams D, Millikan RE, Tu SM, Logothetis CJ. A phase I/II study of strontium-89 combined with gemcitabine in the treatment of patients with androgen independent prostate carcinoma and bone metastases. Cancer. 2003;97(12):2988–94.

    Article  PubMed  CAS  Google Scholar 

  26. Akerley W, Butera J, Wehbe T, Noto R, Stein B, Safran H, Cummings F, Sambandam S, Maynard J, Di Rienzo G, Leone L. A multiinstitutional, concurrent chemoradiation trial of strontium-89, estramustine, and vinblastine for hormone refractory prostate carcinoma involving bone. Cancer. 2002;94(6):1654–60.

    Article  PubMed  CAS  Google Scholar 

  27. Sciuto R, Festa A, Rea S, Pasqualoni R, Bergomi S, Petrilli G, Maini CL. Effects of low-dose cisplatin on 89Sr therapy for painful bone metastases from prostate cancer: a randomized clinical trial. J Nucl Med. 2002;43(1):79–86.

    PubMed  CAS  Google Scholar 

  28. Serafini AN. Samarium Sm-153 lexidronam for the palliation of bone pain associated with metastases. Cancer. 2000;88(12 Suppl):2934–9. Review.

    Article  PubMed  CAS  Google Scholar 

  29. Menda Y, Bushnell DL, Williams RD, Miller S, Thomas MO. Efficacy and safety of repeated samarium-153 lexidronam treatment in a patient with prostate cancer and metastatic bone pain. Clin Nucl Med. 2000;25(9):698–700.

    Article  PubMed  CAS  Google Scholar 

  30. Sartor O. Overview of samarium sm 153 lexidronam in the treatment of painful metastatic bone disease. Rev Urol. 2004;6 Suppl 10:S3–12.

    PubMed  Google Scholar 

  31. Sartor O, Reid RH, Bushnell DL, Quick DP, Ell PJ. Safety and efficacy of repeat administration of samarium Sm-153 lexidronam to patients with metastatic bone pain. Cancer. 2007;109(3):637–43.

    Article  PubMed  CAS  Google Scholar 

  32. Sartor O, Reid RH, Hoskin PJ, Quick DP, Ell PJ, Coleman RE, Kotler JA, Freeman LM, Olivier P, Quadramet 424Sm10/11 Study Group. Samarium-153-lexidronam complex for treatment of painful bone metastases in hormone-refractory prostate cancer. Urology. 2004;63(5):940–5.

    Article  PubMed  Google Scholar 

  33. Morris MJ, Pandit-Taskar N, Carrasquillo J, Divgi CR, Slovin S, Kelly WK, Rathkopf D, Gignac GA, Solit D, Schwartz L, Stephenson RD, Hong C, Delacruz A, Curley T, Heller G, Jia X, O’Donoghue J, Larson S, Scher HI. Phase I study of samarium-153 lexidronam with docetaxel in castration-resistant metastatic prostate cancer. J Clin Oncol. 2009;27(15):2436–42.

    Article  PubMed  CAS  Google Scholar 

  34. Fizazi K, Beuzeboc P, Lumbroso J, Haddad V, Massard C, Gross-Goupil M, Di Palma M, Escudier B, Theodore C, Loriot Y, Tournay E, Bouzy J, Laplanche A. Phase II trial of consolidation docetaxel and samarium-153 in patients with bone metastases from castration-resistant prostate cancer. J Clin Oncol. 2009;27(15):2429–35.

    Article  PubMed  CAS  Google Scholar 

  35. Parker C, et al. First phase III trial of an alpha-pharmaceutical shows improved survival in patients with bone metastases and advanced prostate cancer. The 2011 European Multidisciplinary Cancer Congress is the 16th congress of the European CanCer Organisation (ECCO), the 36th congress of the European Society for Medical Oncology (ESMO) and the 30th congress of European Society for Therapeutic Radiology and Oncology (ESTRO), Stockholm.

    Google Scholar 

  36. de Bono JS, Logothetis CJ, Molina A, Fizazi K, North S, Chu L, Chi KN, Jones RJ, Goodman Jr OB, Saad F, Staffurth JN, Mainwaring P, Harland S, Flaig TW, Hutson TE, Cheng T, Patterson H, Hainsworth JD, Ryan CJ, Sternberg CN, Ellard SL, Fléchon A, Saleh M, Scholz M, Efstathiou E, Zivi A, Bianchini D, Loriot Y, Chieffo N, Kheoh T, Haqq CM, Scher HI, COU-AA-301 Investigators. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med. 2011;364(21):1995–2005.

    Article  PubMed  Google Scholar 

  37. de Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels JP, Kocak I, Gravis G, Bodrogi I, Mackenzie MJ, Shen L, Roessner M, Gupta S, Sartor AO, TROPIC Investigators. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet. 2010;376(9747):1147–54.

    Article  PubMed  Google Scholar 

  38. Nielsen OS, Bentzen SM, Sandberg E, Gadeberg CC, Timothy AR. Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol. 1998;47(3):233–40.

    Article  PubMed  CAS  Google Scholar 

  39. Hartsell WF, Scott CB, Bruner DW, Scarantino CW, Ivker RA, Roach 3rd M, Suh JH, Demas WF, Movsas B, Petersen IA, Konski AA, Cleeland CS, Janjan NA, DeSilvio M. Randomized trial of short- versus long-course radiotherapy for palliation of painful bone metastases. J Natl Cancer Inst. 2005;97(11):798–804.

    Article  PubMed  Google Scholar 

  40. Campos S, Presutti R, Zhang L, Salvo N, Hird A, Tsao M, Barnes EA, Danjoux C, Sahgal A, Mitera G, Sinclair E, DeAngelis C, Nguyen J, Napolskikh J, Chow E. Elderly patients with painful bone metastases should be offered palliative radiotherapy. Int J Radiat Oncol Biol Phys. 2010;76(5):1500–6.

    Article  PubMed  Google Scholar 

  41. Williams BJ, Fox BD, Sciubba DM, Suki D, Tu SM, Kuban D, Gokaslan ZL, Rhines LD, Rao G. Surgical management of prostate cancer metastatic to the spine. J Neurosurg Spine. 2009;10(5):414–22.

    Article  PubMed  Google Scholar 

  42. Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643–8.

    Article  PubMed  Google Scholar 

  43. Rades D, Huttenlocher S, Dunst J, Bajrovic A, Karstens JH, Rudat V, Schild SE. Matched pair analysis comparing surgery followed by radiotherapy and radiotherapy alone for metastatic spinal cord compression. J Clin Oncol. 2010;28(22):3597–604.

    Article  PubMed  Google Scholar 

  44. Hyman DM, Soff GA, Kampel LJ. Disseminated intravascular coagulation with excessive fibrinolysis in prostate cancer: a case series and review of the literature. Oncology. 2011;81(2):119–25.

    Article  PubMed  CAS  Google Scholar 

  45. Din OS, Thanvi N, Ferguson CJ, Kirkbride P. Palliative prostate radiotherapy for symptomatic advanced prostate cancer. Radiother Oncol. 2009;93(2):192–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Center Léon-Bérard, Lyon, France

    Helen Boyle M.D. & Aude Fléchon M.D., Ph.D.

Authors
  1. Helen Boyle M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aude Fléchon M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helen Boyle M.D. .

Editor information

Editors and Affiliations

  1. Lyon-RTH Laënnec School of Medicine, Lyon, France

    Jean-Pierre Droz

  2. University of Liverpool, St Helens Teach, Marshalls Cross Road, St Helens, WA9 3DA, United Kingdom

    Riccardo A. Audisio

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Boyle, H., Fléchon, A. (2013). Clinical Management of Elderly Patients’ Metastatic Prostate Cancer: Other Treatments and Supportive Care. In: Droz, JP., Audisio, R. (eds) Management of Urological Cancers in Older People. Management of Cancer in Older People, vol 1. Springer, London. https://doi.org/10.1007/978-0-85729-999-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-999-4_14

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-986-4

  • Online ISBN: 978-0-85729-999-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation