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Eur J Cancer. 2019 Jul;116:116-136. doi: 10.1016/j.ejca.2019.04.031. Epub 2019 Jun 10.

Updated recommendations of the International Society of Geriatric Oncology on prostate cancer management in older patients.

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Department of Medical Oncology, Centre Léon-Bérard, Lyon, France. Electronic address:
Oncology Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Department of Medical Oncology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Genitourinary Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, USA.
Department of Genitourinary Medical Oncology, Gustave-Roussy, University of Paris-Sud, Villejuif, France.
Urology Department, University Hospital, Saint-Etienne, France.
Department of Oncology, Georges Pompidou Hospital, Paris, France.
Department of Uro-Oncology, University College London Hospitals, London, UK.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Multidisplinary Oncology Institute, Clinique de Genolier, Genolier, Switzerland.
Claude-Bernard-Lyon-1 University and Department of Medical Oncology, Centre Léon-Bérard, Lyon, France.



The median age of prostate cancer diagnosis is 66 years, and the median age of men who die of the disease is eighty years. The public health impact of prostate cancer is already substantial and, given the rapidly ageing world population, can only increase. In this context, the International Society of Geriatric Oncology (SIOG) Task Forces have, since 2010, been developing guidelines for the management of senior adults with prostate cancer.


Since prostate cancer and geriatric oncology are both rapidly evolving fields, a new multidisciplinary Task Force was formed in 2018 to update SIOG recommendations, principally on health status screening tools and treatment. The task force reviewed pertinent articles published between June 2016 and June 2018 and abstracts from European Association of Urology (EAU), European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO) and American Society of Clinical Oncology Genito-urinary (ASCO GU) meetings over the same period, using search terms relevant to prostate cancer, the elderly, geriatric evaluation, local treatments and advanced disease. Each member of the group proposed modifications to the previous guidelines. These were collated and circulated. The final manuscript reflects the expert consensus.


The 2019 consensus is that men aged 75 years and older with prostate cancer should be managed according to their individual health status, and not according to age. Based on available rapid health screening tools, geriatric evaluation and geriatric interventions, the Task Force recommends that patients are classified according to health status into three groups: (1) 'healthy' or 'fit' patients should have the same treatment options as younger patients; (2) 'vulnerable' patients are candidates for geriatric interventions which-if successful-may make it appropriate for them to receive standard treatment and (3) 'frail' patients with major impairments who should receive adapted or palliative treatment. The 2019 SIOG Task Force recommendations also discuss prospects and unmet needs for health status evaluation in everyday practice in older patients with prostate cancer.


Geriatric evaluation; Older patients; Prostate cancer; literature update; treatment


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