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Context Prostate cancer is the most frequent male cancer. Since the median age of diagnosis is 66 yr, many patients require both geriatric and urologic evaluation if treatment is to be tailored to individual circumstances including comorbidities and frailty. Objective To update the 2014 International Society of Geriatric Oncology (SIOG) guidelines on prostate cancer in men aged >70 yr. The update includes new material on health status evaluation and the treatment of localised, advanced, and castrate-resistant disease. Data acquisition A multidisciplinary SIOG task force reviewed pertinent articles published during 2013–2016 using search terms relevant to prostate cancer, the elderly, geriatric evaluation, local treatments, and castration-refractory/resistant disease. Each member of the group proposed modifications to the previous guidelines. These were collated and circulated. The final manuscript reflects the expert consensus. Data synthesis Elderly patients should be managed according to their individual health status and not according to age. Fit elderly patients should receive the same treatment as younger patients on the basis of international recommendations. At the initial evaluation, screening for cognitive impairment is mandatory to establish patient competence in making decisions. Initial evaluation of health status should use the validated G8 screening tool. Abnormal scores on the G8 should lead to a simplified geriatric assessment that evaluates comorbid conditions (using the Cumulative Illness Score Rating-Geriatrics scale), dependence (Activities of Daily Living) and nutritional status (via estimation of weight loss). When patients are frail or disabled or have severe comorbidities, a comprehensive geriatric assessment is needed. This may suggest additional geriatric interventions. Conclusions Advances in geriatric evaluation and treatments for localised and advanced disease are contributing to more appropriate management of elderly patients with prostate cancer. A better understanding of the role of active surveillance for less aggressive disease is also contributing to the individualisation of care. Patient summary Many men with prostate cancer are elderly. In the physically fit, treatment should be the same as in younger patients. However, some elderly prostate cancer patients are frail and have other medical problems. Treatment in the individual patient should be based on health status and patient preference. [ABSTRACT FROM AUTHOR]

Purpose: Cancer is the leading cause of death among patients aged 65 years and older. In this population, the cancer diagnosis is often made at a more advanced stage and worse prognosis than in younger patients. Specific mortality in older patients is superior to that reported in their younger counterparts. Moreover, the impact of curative treatment that has proven benefit in overall population may be not well studied in the sub-group of older patients. Thus, the management of cancer in the elderly is a major public health concern in most Western countries. Methods/results: In this review, we summarize this challenging treatment decision-making in older urologic patients with prostate, kidney or bladder cancer. The estimation of life expectancy remains a difficult task. Chronological age should not be considered as the main decisive factor anymore when considering aggressive cancer treatment. Comorbidities increase the complexity of cancer management and affect survival. Multidisciplinary evaluation and comprehensive geriatrics assessment using specific scales are critical to improve the treatment decision-making and to minimize both overtreatment of low-risk disease and undertreatment of high-risk disease. When an aggressive and potential quality-of-life-threatening treatment is scheduled after this comprehensive geriatrics assessment, personalized patient care must be early predefined by the geriatric team. Conclusions: In the elderly, an enhanced support including specific geriatric assessment and management optimizes the treatment course, including preoperative optimization, prevents treatment-related complications and loss of autonomy using or not geriatrics clinic or rehabilitation units, and limits the length of hospital stay and costs. [ABSTRACT FROM AUTHOR]

Abstract: Oncologists usually base treatment decision on the assessment of patients’ performance status (PS). This study was undertaken to explore the ability of KPS to correctly assess the PS of elderly cancer patients, comparing it to a validated geriatric tool named Physical Performance Test (PPT). One single examiner assessed elderly cancer patients’ PS at registration in our institution and performed the PPT on patients with KPS ≥60. A sample of 152 patients actually underwent PPT. A low refusal rate was observed (<5%). Most patients (82%) had a high PS (KPS ≥80), whereas only 20% had no health impairment according to PPT scores. Patients’ gender and disease stage did not correlate with PPT scores. The KPS seems to be a less accurate tool than the PPT to assess functional status of elderly cancer patients. Then PPT could be used as an inclusion criterion instead of KPS before cancer treatment decision. [ABSTRACT FROM AUTHOR]

Breast cancer is a common tumour in the elderly and management of early disease in particular is a major challenge for oncologists and geriatricians alike. The process should begin with the Comprehensive Geriatric Assessment (CGA), which should be undertaken before any decisions about treatment are made. The important role of co-morbidities and their effect on life expectancy also need to be taken into account when making treatment decisions. The primary treatments for early breast cancer are surgery, adjuvant radiotherapy and adjuvant systemic therapy. Unfortunately, lack of a specific literature relating to early breast cancer in the elderly means formulating an evidence-based approach to treatment in this context is difficult. We have developed a new approach based on the CGA and comprehensive oncological assessment. This approach facilitates the development of an individualized oncogeriatric care plan and follow-up based on several considerations: the average patient's life expectancy at a given age; the patient's co-morbidities, level of dependence, and the impact of these considerations on diagnostic and therapeutic options as well as life expectancy; and the potential benefit-risk balance of treatment. In the elderly patient with breast cancer, the standard primary therapy is surgical resection (mastectomy or breast-conserving therapy). While node dissection is a major component of staging and local control of breast cancer, no data are available to guide decision-making in women aged >70 years. Primary endocrine therapy (tamoxifen) should be offered to elderly women with estrogen receptor (ER)-positive breast cancer only if they are unfit for or refuse surgery. Trials are needed to evaluate the clinical effectiveness of aromatase inhibitors as primary therapy for infirm older patients with ER-positive tumours. Breast irradiation should be recommended to older women with a life expectancy >5 years, particularly those with large tumours, positive lymph nodes or negative hormone receptors. Adjuvant hormone therapy remains a reasonable therapeutic option in elderly women with positive hormone receptor tumours. Aromatase inhibitors have demonstrated a better toxicity profile and effectiveness as adjuvant therapy than tamoxifen in young postmenopausal women but have not been specifically studied in the elderly population. The efficacy of adjuvant chemotherapy for breast cancer has been established by meta-analysis and numerous randomized trials but, again, women aged =70 years have rarely been included in such trials. At present, it is difficult to provide a validated recommendation for use of adjuvant chemotherapy in elderly patients with breast cancer. There are no follow-up recommendations specifically for elderly patients after treatment of early breast cancer. However, American Society of Clinical Oncology breast cancer surveillance guidelines suggest physician office visits every 3-6 months for 3 years, followed by visits very 6-12 months for 2 years, then annually. Women taking aromatase inhibitors should also undergo bone mineral density measurement every 2 years. The new approach to assessment and management of early breast cancer in the elderly outlined in this article should be considered an intermediate step because additional evidence to support clinical practice is still needed. Bearing this in mind, physicians should encourage enrolment of elderly breast cancer patients in clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: Quality of life (QOL) is a critical issue in elderly patients with cancer. In the geriatric population, cancer is often associated with other chronic conditions possibly affecting QOL. This prospective study aimed to evaluate the validity of two QOL questionnaires, EORTC QLQ-C30 and SF-36, in older cancer patients. Seventy-two of 87 male patients with genitourinary cancer (median age, 76 years) completed the questionnaires (83% response rate). Internal consistency reliability was high (α ≥0.7), except for SF-36 cognitive function (α =0.62) and QLQ-C30 general health status (α =0.57). QLQ-C30 and SF-36 appear similarly reliable for QOL assessment in this population. However, cognitive function and functional status, two factors likely to influence the value of QOL self-assessment, are poorly taken into account whereas they are correctly explored by the comprehensive geriatric assessment (CGA) procedure. QOL assessment in elderly cancer patients should therefore be associated with CGA to better meet the expectations of clinicians. [Copyright &y& Elsevier]

Objective: Patients with painful conditions often suffer from sleep disturbances. However, changes in sleep pattern per se could also influence pain tolerance. Untreated obstructive sleep apnea (OSA) causes major disturbances in sleep pattern. The aim of this study was to assess whether continuous positive airway pressure (CPAP) treatment in elderly patients with OSA would result in improved pain tolerance. Design: Randomized, double-blind crossover study. Setting: Geriatric sleep center based in Antoine Charial University Hospital (Lyon, France). Participants: A total of 13 consecutive OSA patients aged 70 and older randomly assigned CPAP treatment (lowCPAP versus highCPAP). Eleven patients completed the study. Measurements: Overnight sleep recording, electrical pain tolerance assessment, and visual analog scale for sleep quality were performed. Results: Both low- and highCPAP treatment significantly improved respiratory parameters. However, compared with baseline, the electrical pain tolerance score was significantly enhanced (analgesic effect) only under highCPAP treatment (21.2 ±10.9 versus 28.4 ±16.0; P = .03). Conclusion: The treatment of OSA with CPAP would have an analgesic effect. This would represent a unique outcome attributed to CPAP treatment. Given the high prevalence of both OSA and chronic pain conditions in the elderly; our findings could hold many implications for very large segments of the elderly population. [Copyright &y& Elsevier]

Summary: There is currently little data showing that older adults can derive benefit from cancer screening. Advancing age is associated with an increasing prevalence of cancer and other chronic conditions, or comorbidity, and questions remain about the interactions between comorbidity and cancer screening in the elderly population. In this Review, we assess the available evidence on the effects of comorbidity on cancer screening in elderly individuals. In view of the high heterogeneity of existing data, consistent recommendations cannot be made. Decisions on cancer screening in older adults should be based on an appropriate assessment of each individual''s health status and life expectancy, the benefits and harms of screening procedures, and patient preferences. We suggest that Comprehensive Geriatric Assessment might be a necessary step to identify candidates for cancer screening in the elderly population. Specific clinical trials should be done to improve the evidence and show the effectiveness and cost-effectiveness of cancer screening in older adults. [Copyright &y& Elsevier]

Chemotherapy is an essential therapy in the fight against cancer. Polypathology and polymedication are often encountered in elderly patients, making this population especially at risk for adverse drug reactions, and particularly with cytotoxic drugs. The objective of this study was to build a model to predict high‐grade toxicity in elderly patients treated with docetaxel. Data from the trial TAX‐108 have been used to create the model. The variable to predict was the occurrence of grade 3 or 4 toxicity. The explanatory variables entered in the model were anthropometric and biological characteristics of patients at inclusion; fragility criteria (SMAF, CIRS‐G, performance status); location of the primary tumor; chemotherapy history, radiotherapy or surgery; weekly dose of docetaxel, cumulative dose administered. A Bayesian network model was developed using a global search procedure and an Expectation–Maximization algorithm. A 10‐fold cross‐validation was performed. A toxicity of grade 3 or higher was observed in 54% of patients. The variables providing the most information were the primary site (19.4%), the dose per course (17.5%), and albuminemia (13.1%). The area under the curve of the model obtained after cross‐validation was 74 ± 1.4%. The model built allows classifying correctly 71.21 ± 0.9% of patients in our sample in the cross‐validation procedure. The sensitivity and specificity of the model were 75 and 67%, respectively, and the positive and negative predictive values were 73 and 69%. The encouraging results from this first study show that Bayesian networks could help assess the benefit–risk ratio of chemotherapy in elderly patients. [ABSTRACT FROM AUTHOR]

Background: Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13). Patients and Methods: The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate. Results: Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P =  0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival. Conclusion: With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy. [ABSTRACT FROM AUTHOR]

Simple Summary: The prognostic assessment of older cancer patients is complicated by their heterogeneity. We aimed to assess the prognostic value of routinely measured inflammatory biomarkers. We performed a pooled analysis of prospective multicenter cohorts of cancer patients aged ≥70. We measured CRP and albumin, and calculated Glasgow Prognostic Score (GPS) and CRP/albumin ratio. The GPS has three levels (0 = CRP ≤ 10 mg/L, albumin ≥ 35 g/L, i.e., normal values; 1 = one abnormal value; 2 = two abnormal values). Overall, 1800 patients were analyzed (mean age: 79 ± 6; males: 62%; metastases: 38%). The GPS and CRP/albumin ratio were independently associated with mortality. The discriminative power of the baseline clinical model was increased by adding GPS and CRP/albumin ratio. Routine inflammatory biomarkers add prognostic value to clinical factors in older cancer patients. Background: The prognostic assessment of older cancer patients is complicated by their heterogeneity. We aimed to assess the prognostic value of routine inflammatory biomarkers. Methods: A pooled analysis of prospective multicenter cohorts of cancer patients aged ≥70 was performed. We measured CRP and albumin, and calculated Glasgow Prognostic Score (GPS) and CRP/albumin ratio. The GPS has three levels (0 = CRP ≤ 10 mg/L, albumin ≥ 35 g/L, i.e., normal values; 1 = one abnormal value; 2 = two abnormal values). One-year mortality was assessed using Cox models. Discriminative power was assessed using Harrell's C index (C) and net reclassification improvement (NRI). Results: Overall, 1800 patients were analyzed (mean age: 79 ± 6; males: 62%; metastases: 38%). The GPS and CRP/albumin ratio were independently associated with mortality in patients not at risk of frailty (hazard ratio [95% confidence interval] = 4.48 [2.03–9.89] for GPS1, 11.64 [4.54–29.81] for GPS2, and 7.15 [3.22–15.90] for CRP/albumin ratio > 0.215) and in patients at risk of frailty (2.45 [1.79–3.34] for GPS1, 3.97 [2.93–5.37] for GPS2, and 2.81 [2.17–3.65] for CRP/albumin ratio > 0.215). The discriminative power of the baseline clinical model (C = 0.82 [0.80–0.83]) was increased by adding GPS (C = 0.84 [0.82–0.85]; NRI events (NRI+) = 10% [2–16]) and CRP/albumin ratio (C = 0.83 [0.82–0.85]; NRI+ = 14% [2–17]). Conclusions: Routine inflammatory biomarkers add prognostic value to clinical factors in older cancer patients. [ABSTRACT FROM AUTHOR]