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Locally Advanced Prostate Cancer: Optimal Therapy in Older Patients

  • Therapy in Practice
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Abstract

There is no standard treatment for locally advanced prostate cancer. Even the definition is still unclear. Locally advanced disease may refer to over-staged well-curable tumors as well as to advanced and probably incurable cancers. Similar uncertainties are present regarding the definition of ‘old’ in this context. Conservatively treated locally advanced prostate cancer is associated with poor survival outcome. With the increasing life expectancy, in the absence of curative treatment, even patients in their ninth decade of life may later suffer from symptoms of aggressive prostate cancer and are at a high risk of death from prostate cancer that might be prevented at least in part by early intervention. On the other hand, functional results after prostate cancer treatment are worse in elderly patients. In this article we discuss aspects of the management of locally advanced prostate cancer in the elderly with special focus on the recommendation of current clinical guidelines.

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References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.

    Article  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.

  3. Robert Koch-Institut und Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V.: Krebs in Deutschland 2007–2008. Häufigkeiten und Trends. 8. überarbeitete Auflage, 2012. http://www.rki.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/kid_2012/krebs_in_deutschland_2012.pdf?__blob=publicationFile. Accessed 5 Jul 2013.

  4. Brawley OW. Prostate cancer epidemiology in the United States. World J Urol. 2012;30:195–200.

    Article  PubMed  Google Scholar 

  5. Bechis SK, Carroll PR, Cooperberg MR. Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol. 2011;29:235–41.

    Article  PubMed  Google Scholar 

  6. Jani AB. Management strategies for locally advanced prostate cancer. Drugs Aging. 2006;23:119–29.

    Article  PubMed  Google Scholar 

  7. Wirth MP, Hakenberg OW, Froehner M. Optimal treatment of locally advanced prostate cancer. World J Urol. 2007;25:169–76.

    Article  PubMed  Google Scholar 

  8. Joniau SG, Van Baelen AA, Hsu CY, Van Poppel HP. Complications and functional results of surgery for locally advanced prostate cancer. Adv Urol. 2012;2012:706309.

  9. Akre O, Garmo H, Adolfsson J, Lambe M, Bratt O, Stattin P. Mortality among men with locally advanced prostate cancer managed with noncurative intent: a nationwide study in PCBaSe Sweden. Eur Urol. 2011;60:554–63.

    Article  PubMed  Google Scholar 

  10. Chin JL, Al-Zahrani AA, Autran-Gomez AM, Williams AK, Bauman G. Extended followup oncologic outcome of randomized trial between cryoablation and external beam therapy for locally advanced prostate cancer (T2c-T3b). J Urol. 2012;188:1170–5.

    Article  PubMed  Google Scholar 

  11. Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, Fearn PA, Kattan MW. Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst. 2006;98:715–7.

    Article  PubMed  Google Scholar 

  12. Deutsche Gesellschaft für Urologie e. V.: Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms. Version 2.0-1. Aktualisierung 2011. Verfügbar auf der Website der Deutschen Gesellschaft für Urologie (DGU). http://www.urologenportal.de/fileadmin/MDB/PDF/S3_LL_PCAS3_PCa_Aktualisierung_2011_110912f.pdf. Accessed 5 Jul 2013.

  13. Ohori M, Kattan MW, Koh H, Maru N, Slawin KM, Shariat S, et al. Predicting the presence and side of extracapsular extension: a nomogram for staging prostate cancer. J Urol. 2004;171:1844–9.

    Article  PubMed  Google Scholar 

  14. Jung AJ, Coakley FV, Shinohara K, Carroll PR, Kurhanewicz J, Cowan JE, Westphalen AC. Local staging of prostate cancer: comparative accuracy of T2-weighted endorectal MR imaging and transrectal ultrasound. Clin Imaging. 2012;36:547–52.

    Article  PubMed  Google Scholar 

  15. Bill-Axelson A, Holmberg L, Ruutu M, Garmo H, Stark JR, Busch C, SPCG-4 Investigators, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2011;364:1708–17.

    Article  PubMed  CAS  Google Scholar 

  16. Froehner M, Wirth MP. Early prostate cancer—treat or watch? N Engl J Med. 2011;365:568.

    Article  PubMed  CAS  Google Scholar 

  17. Lu-Yao GL, Albertsen PC, Moore DF, Shih W, Lin Y, DiPaola RS, et al. Outcomes of localized prostate cancer following conservative management. JAMA. 2009;302:1202–9.

    Article  PubMed  CAS  Google Scholar 

  18. Hamstra DA, Bae K, Pilepich MV, Hanks GE, Grignon DJ, McGowan DG, et al. Older age predicts decreased metastasis and prostate cancer-specific death for men treated with radiation therapy: meta-analysis of radiation therapy oncology group trials. Int J Radiat Oncol Biol Phys. 2011;81:1293–301.

    Article  PubMed  Google Scholar 

  19. Ko J, Falzarano SM, Walker E, Streator Smith K, Stephenson AJ, Klein EA, Magi-Galluzzi C. Prostate cancer patients older than 70 years treated by radical prostatectomy have higher biochemical recurrence rate than their matched younger counterpart. Prostate. 2013;73:897–903.

    Article  PubMed  Google Scholar 

  20. Kunz I, Musch M, Roggenbuck U, Klevecka V, Kroepfl D. Tumour characteristics, oncological and functional outcomes in patients aged ≥ 70 years undergoing radical prostatectomy. BJU Int. 2013;111:E24–9.

    Article  PubMed  Google Scholar 

  21. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD, et al. EAU guidelines on prostate cancer. Update 2013. http://www.uroweb.org/gls/pdf/09_Prostate_Cancer_LR.pdf. Accessed 5 Jul 2013.

  22. Albertsen PC, Moore DF, Shih W, Lin Y, Li H, Lu-Yao GL. Impact of comorbidity on survival among men with localized prostate cancer. J Clin Oncol. 2011;29:1335–41.

    Article  PubMed  Google Scholar 

  23. Froehner M, Koch R, Litz RJ, Hakenberg OW, Wirth MP. Which patients are at the highest risk of dying from competing causes ≤ 10 years after radical prostatectomy? BJU Int. 2012;110:206–10.

    Article  PubMed  Google Scholar 

  24. Berglund RK, Tangen CM, Powell IJ, Lowe BA, Haas GP, Carroll PR, et al. Ten-year follow-up of neoadjuvant therapy with goserelin acetate and flutamide before radical prostatectomy for clinical T3 and T4 prostate cancer: update on Southwest Oncology Group Study 9109. Urology 2012;79:633–7.

    Google Scholar 

  25. Yao XD, Liu XJ, Zhang SL, Dai B, Zhang HL, Ye DW. Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer: a comparison with clinically localized prostate cancer. Asian J Androl. 2013;15:241–5.

    Article  PubMed  Google Scholar 

  26. Mitchell CR, Boorjian SA, Umbreit EC, Rangel LJ, Carlson RE, Karnes RJ. 20-year survival after radical prostatectomy as initial treatment for cT3 prostate cancer. BJU Int. 2012;110:709–13.

    Article  Google Scholar 

  27. Shikanov S, Desai V, Razmaria A, Zagaja GP, Shalhav AL. Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after surgery. J Urol. 2010;183:1803–7.

    Article  PubMed  Google Scholar 

  28. Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013;368:436–45.

    Article  PubMed  CAS  Google Scholar 

  29. Mottet N, Peneau M, Mazeron JJ, Molinie V, Richaud P. Addition of radiotherapy to long-term androgen deprivation in locally advanced prostate cancer: an open randomised phase 3 trial. Eur Urol. 2012;62:213–9.

    Article  PubMed  Google Scholar 

  30. Iversen P, McLeod DG, See WA, Morris T, Armstrong J, Wirth MP, Casodex Early Prostate Cancer Trialists’ Group. Antiandrogen monotherapy in patients with localized or locally advanced prostate cancer: final results from the bicalutamide Early Prostate Cancer programme at a median follow-up of 9.7 years. BJU Int. 2010;105:1074–81.

    Article  PubMed  CAS  Google Scholar 

  31. Zelefsky MJ, Kollmeier M, Cox B, Fidaleo A, Sperling D, Pei X, et al. Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;84:125–9.

    Article  PubMed  Google Scholar 

  32. Abdollah F, Sun M, Thuret R, Jeldres C, Tian Z, Briganti A, et al. A competing-risks analysis of survival after alternative treatment modalities for prostate cancer patients: 1988–2006. Eur Urol. 2011;59:88–95.

    Article  PubMed  Google Scholar 

  33. Ciezki JP, Hsu IC, Abdel-Wahab M, Arterbery VE, Frank SJ, Mohler JL, Moran BJ, American College of Radiology Appropriateness Criteria, et al. American College of Radiology Appropriateness Criteria(®)–locally advanced (high-risk) prostate cancer. Clin Oncol (R Coll Radiol). 2012;24:43–51.

    Article  CAS  Google Scholar 

  34. Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff RO, et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet. 2002;360(9327):103–6.

    Google Scholar 

  35. Bolla M, de Reijke TM, Van Tienhoven G, Van den Bergh AC, Oddens J, Poortmans PM, EORTC Radiation Oncology Group and Genito-Urinary Tract Cancer Group, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009;360:2516–27.

    Article  PubMed  CAS  Google Scholar 

  36. US Food and Drug Administration. FDA drug safety communication: update to ongoing safety review of GnRH agonists and notification to manufacturers of GnRH agonists to add new safety information to labeling regarding increased risk of diabetes and certain cardiovascular diseases. http://www.fda.gov/Drugs/DrugSafety/ucm229986.htm. Accessed 5 Jul 2013.

  37. Levine GN, D’Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, American Heart Association Council on Clinical Cardiology and Council on Epidemiology and Prevention, the American Cancer Society, and the American Urological Association, et al. 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. CA Cancer J Clin. 2010;60:194–201.

    Article  PubMed  Google Scholar 

  38. Nguyen P, Je Y, Schutz FAB, Hoffman KE, Hu JC, Parekh A, et al. Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. JAMA. 2011;306:2359–66.

    Article  PubMed  CAS  Google Scholar 

  39. Froehner M, Wirth MP. Re: association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. Eur Urol. 2012;62:350.

    Article  PubMed  Google Scholar 

  40. Friedlander JI, Duty BD, Okeke Z, Smith AD. Obstructive uropathy from locally advanced and metastatic prostate cancer: an old problem with new therapies. J Endourol. 2012;26:102–9.

    Article  PubMed  Google Scholar 

  41. Thomas DJ, Balaji VJ, Coptcoat MJ, Abercrombie GF. Acute urinary retention secondary to carcinoma of the prostate. Is initial channel TURP beneficial? J R Soc Med. 1992;85:318–9.

    PubMed  CAS  Google Scholar 

  42. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology (NCCN Guideline®): prostate cancer, version I. 2013. http://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed 5 Jul 2013.

  43. Bolla M, Gonzalez D, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. Improved survival in patients with locally advanced prostate cancer treated with radiotherapy and goserelin. N Engl J Med. 1997;337:295–300.

    Article  PubMed  CAS  Google Scholar 

  44. Pilepich MV, Krall JM, al-Sarraf M, John MJ, Doggett RL, Sause WT, et al. Androgen deprivation with radiation therapy compared with radiation therapy alone for locally advanced prostatic carcinoma: a randomized comparative trial of the Radiation Therapy Oncology Group. Urology 1995;45:616–23.

    Google Scholar 

  45. Denham JW, Steigler A, Lamb DS, Joseph D, Turner S, Matthews J, et al. Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial. Lancet Oncol. 2011;12:451–9.

    Article  PubMed  CAS  Google Scholar 

  46. Lowrance WT, Elkin EB, Yee DS, Feifer A, Ehdaie B, Jacks LM, et al. Locally advanced prostate cancer: a population-based study of treatment patterns. BJU Int. 2012;109:1309–14.

    Article  PubMed  Google Scholar 

  47. Kim JK, Cho SY, Jeong CW, Lee SB, Ku JH, Hong SK, et al. Patients aged more than 70 had higher risk of locally advanced prostate cancers and biochemical recurrence in Korea. BJU Int. 2012;110:505–9.

    Article  PubMed  Google Scholar 

  48. Cooperberg MR, Konety BR. Management of localized prostate cancer in men over 65 years. Curr Opin Urol. 2009;19:309–14.

    Article  PubMed  Google Scholar 

  49. Du XL, Fang S, Coker AL, Sanderson M, Aragaki C, Cormier JN, et al. Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer. 2006;106:1276–85.

    Article  PubMed  Google Scholar 

  50. Droz JP, Balducci L, Bolla M, Emberton M, Fitzpatrick JM, Joniau S, et al. Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol. 2010;73:68–91.

    Article  PubMed  Google Scholar 

  51. Situmorang GR, Umbas R, Mochtar CA, Santoso RB. Prostate cancer in younger and older patients: do we treat them differently? Asian Pac J Cancer Prev. 2012;13:4577–80.

    Article  PubMed  Google Scholar 

  52. Shelke AR, Mohile SG. Treating prostate cancer in elderly men: how does aging affect the outcome? Curr Treat Options Oncol. 2011;12:263–75.

    Article  PubMed  Google Scholar 

  53. Ernstmann N, Jaeger J, Kowalski C, Pfaff H, Weißbach L. Elderly prostate cancer patients: patient information and shared decision making [in German]. Urologe A. 2013;52:847–52.

    Article  PubMed  CAS  Google Scholar 

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Conflicts of Interest

No sources of funding were used to assist in the preparation of this article. Dr. Froehner and Dr. Wirth declare no conflicts of interest, financial or otherwise, in connection with this article.

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  1. Department of Urology, University Hospital “Carl Gustav Carus”, Dresden University of Technology, Fetscherstrasse 74, 01304, Dresden, Germany

    Michael Froehner & Manfred P. Wirth

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  1. Michael Froehner
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Correspondence to Michael Froehner.

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Froehner, M., Wirth, M.P. Locally Advanced Prostate Cancer: Optimal Therapy in Older Patients. Drugs Aging 30, 959–967 (2013). https://doi.org/10.1007/s40266-013-0123-7

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