Management of Urological Cancers in Older People PDF
Preview Management of Urological Cancers in Older People
M anagement of Cancer in Older People J ean-Pierre D roz • Riccardo A. Audisio E ditors R iccardo A. A udisio Series Editor M anagement of Urological Cancers in Older People E ditors J ean-Pierre D roz, M.D., Ph.D. R iccardo A. A udisio, M.D., FRCS C laude-Bernard-Lyon 1 University D epartment of Surgical Oncology Department of Medical Oncology U niversity of Liverpool C entre Léon-Bérard S t Helens Teaching Hospital L yon St Helens F rance U K Series Editor Riccardo A. Audisio, M.D., FRCS Department of Surgical Oncology University of Liverpool St Helens Teaching Hospital St Helens UK I SBN 978-0-85729-986-4 I SBN 978-0-85729-999-4 (eBook) D OI 10.1007/978-0-85729-999-4 S pringer London Heidelberg New York Dordrecht Library of Congress Control Number: 2012949473 © Springer-Verlag London 2 013 T his work is subject to copyright. 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P rinted on acid-free paper S pringer is part of Springer Science+Business Media (www.springer.com) P reface A s the population is aging to unprecedented levels, more and more older patients are referred to our clinics. It might be assumed that we do not need any specialized knowledge as we are all used to dealing with older patients in our daily practice. On the other hand, it has become very clear that older patients with cancer represent an entirely unique subset, presenting with special needs and requiring tailored care. G enitourinary cancers represent a unique model in our practice, as the three major urological malignancies have different impacts on the risk of dying of cancer. Therefore, the confl i ct between the risk of dying of cancer and dying of other causes poses uncertainties in the design of a treatment plan. Confl i cting risks of death are present in older patients, the most important being comorbidities, but dependence, malnutrition, fall, and even cognitive impairment may also play important roles. Tools are now available to assess the patients’ health status, and they come under the name of Comprehensive Geriatric Assessment (CGA). These tools help to predict the individual likelihood of survival. This prediction is, however, only a probability and not a certainty. P atients with low-risk prostate cancers are unlikely to die of their malignancy, while high-risk, life-threatening prostate cancers can develop. This is also the case with kidney cancer: small volume renal lesions and slow-growing masses are unlikely to be cancerous, and even when proved to be malignant, they generally do not develop into life-threatening conditions. Conversely, infi l trating bladder cancer presents with a completely different scenario, and this poor-risk condition requires surgical treatment. T he basic question is: what are the chances of living in relation to a health status evaluation? What is the chance of living with cancer rather than surviving the cancer treatment? This fi n e balance is more accurately estimated by weighing frailty (CGA) against cancer prognosis. Estimating these factors allows us to develop a patient- centered decision-making process for each individual patient. I t is important to appreciate how principles for the implementation of these d ecision-making processes are still needed. These aspects, cancer prognosis and the v vi Preface possibility to undergo treatment, as well as health status and need for a geriatric intervention, must be carefully considered. N o universal rule is available; hence our personal experience is essential in adapt- ing the acquired knowledge into our clinical practice. The implementation of sophis- ticated geriatric tools into our oncology/urology practice is a big challenge. Different instruments have been developed to assist screening patients’ health status and strat- ifying them into risk groups: i.e., fi t , vulnerable, frail, and “too sick” patients. These tools have limited effi c iency in decision making, but are extremely useful in clinical practice. T his book has been specifi c ally designed and developed with the purpose to assist clinicians in optimizing their clinical proactivity when dealing with senior urological patients. Our aim was to review all different aspects of a geriatric oncol- ogy approach to urological cancers. Some sections might overlap, but they refl e ct the numerous and different schools of thought. It is indeed the reader’s challenge to develop a critical interpretation of these different approaches. Eventually the reader will be inspired to build their own decision-making process on the basis of personal experience. G enitourinary cancers are generally cancers of older patients, especially prostate and bladder cancers. The available literature is rich in experiences of treating older patients with prostate and bladder tumors as these cancers are highly prevalent among the elderly. Non-Hodgkin lymphomas are also relatively frequent in elderly patients, thus a chapter on this topic has been included. C onversely, there are only minor differences evident in the prevalence of most other genitourinary cancers in older patients when compared with their prevalence in the general population. One exception is testicular cancer: germ cell tumors occur in patients younger than 50 years, and for this reason this tumor type is not included in this book. Other tumors show no age-related specifi c ity, i.e., penile cancer, adre- nal tumors, retroperitoneal sarcoma, or upper urinary cancers. It was nevertheless interesting to review the published data relevant to older patients, even though there was no specifi c decision-making processes to be developed. W e would like to congratulate all the authors and thank them for their enthusiasm in summarizing their experience. A special note of gratitude goes to Dr. Helen Boyle for her generous support on numerous areas across this editorial project. I t is our hope that this book might become a useful tool to assist the dissemina- tion and implementation of geriatric oncology into urological practice. Jean-Pierre Droz, M.D., Ph.D. Riccardo A. Audisio, M.D., FRCS C ontents Part I Background and Epidemiology 1 Background and Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Jan Willem Coebergh and Rob H.A. Verhoeven 2 Health Status Evaluation of Elderly Patients with Genitourinary Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Catherine Terret and Gilles Albrand 3 Nomograms and the Elderly: Applications in Genitourinary Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Brandon K. Isariyawongse and Michael W. Kattan 4 Renal Function in Elderly and in Relationship with Management of Genitourinary Tumors . . . . . . . . . . . . . . . . . . . . . . . 51 Muriel Rainfray, Cecile Mertens, and Sophie Duc Part II Prostate Cancer: General Considerations 5 Prostate Cancer Screening or Early Diagnosis in Senior Adults? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Jean Etienne Terrier, Helen Boyle, and Nicolas Mottet 6 Androgen Deprivation in Elderly Prostate Cancer Patients: Side Effects and Their Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Mohamed Omar Bishr and Fred Saad Part III Prostate Cancer: Localized Disease 7 Prognostic Factors of Localized Prostate Cancer in Elderly Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Barry B. McGuire and John M. Fitzpatrick vii viii Contents 8 Prostatectomy in Elderly Prostate Cancer Patients . . . . . . . . . . . . . . 105 Hein Van Poppel 9 Radiotherapy in Elderly Prostate Cancer Patients . . . . . . . . . . . . . . 121 Pascal Pommier 10 Selective Minimally Invasive Therapy in Older Patients for Localized Prostate Cancer: A Way to Mitigate Harm and Retain Benefi t ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Louise Dickinson, Hashim Uddin Ahmed, and Mark Emberton 11 Active Surveillance and Watchful Waiting in Indolent Elderly Prostate Cancer Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Nicolas Mottet and Helen Boyle 12 Decision Making in Elderly Localized Prostate Cancer . . . . . . . . . . 163 Nicolas Mottet, Helen Boyle, and Jean-Pierre Droz Part IV Prostate Cancer: Metastatic Disease 13 Clinical Management of Elderly Patients with Metastatic Prostate Cancer Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Guru Sonpavde and Cora N. Sternberg 14 Clinical Management of Elderly Patients’ Metastatic Prostate Cancer: Other Treatments and Supportive Care . . . . . . . . 203 Helen Boyle and Aude Fléchon 15 New Treatment Developments Applied to Elderly Patients . . . . . . . 217 Deborah Mukherji, Carmel J. Pezaro, and Johann S. De-Bono Part V Bladder Cancer 16 Management of Superfi c ial Bladder Cancer in Elderly Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Marco Oderda, Paolo Gontero, and Steven Joniau 17 Radical Cystectomy in Muscle-Infi l trative Bladder Cancer and Conservative Treatment in Localized Disease . . . . . . . . 247 Massimo Maffezzini 18 Chemotherapy for Elderly Patients with Advanced Transitional Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Damien Pouessel and Stéphane Culine 19 Tailored Treatment for Bladder Cancer in Older Patients . . . . . . . 271 Riccardo A. Audisio, Catherine Terret, Helen Boyle, Aude Fléchon, and Jean-Pierre Droz Contents ix Part VI Renal Cancer 20 Surgery or Observation for Small Renal Masses in Older Patients? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 Jean-Pierre Droz and Riccardo A. Audisio 21 Treatment of Metastatic Kidney Cancer in the Elderly . . . . . . . . . . 287 Helen Boyle and Sylvie Négrier Part VII Rare Cancers 22 Carcinoma of the Penis in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . 303 Jérôme Rigaud and Olivier Bouchot 23 Lymphomas of the Testis in Elderly Patients . . . . . . . . . . . . . . . . . . . 323 Catherine Thieblemont, Claire Benet, and Josette Briere 24 Upper Urinary Tract Tumors in Elderly Patients . . . . . . . . . . . . . . . 335 Fabio Campodonico 25 Adrenal Tumors in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 Jean-Louis Peix and Jean-Christophe Lifante 26 Retroperitoneal Tumors in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . 353 Pierre Meeus and Helen Boyle Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
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