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Current Geriatrics Reports
Published in: Current Geriatrics Reports 1/2015

01-03-2015 | Geriatric Urology (TJ Guzzo and DJ Canter, Section Editors)

Evaluation and Management of the Geriatric Urologic Oncology Patient

Authors: Maxim J. McKibben, Angela B. Smith

Published in: Current Geriatrics Reports | Issue 1/2015

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Abstract

The geriatric population presents a unique set of challenges in urologic oncology. In addition to the known natural history of disease, providers must also consider patient factors such as functional and nutritional status, comorbidities and social support when determining the treatment plan. The development of frailty measures and biomarkers to estimate surgical risk shows promise, with several assessment tools predictive of surgical complications. Decreased dependence on chronologic age is important when assessing surgical fitness, as age cutoffs prevent appropriate treatment of many elderly patients who would benefit from surgery. Within bladder, kidney and prostate cancers, continued refinement of surgical techniques offers a broader array of options for the geriatric patient than previously available.
Literature
1.
2.
3.
4.
Firat S, Bousamra M, Gore E, Byhardt RW. Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2002;52(4):1047–57.PubMedCrossRef
5.
Peek ME. Screening mammography in the elderly: A review of the issues. J Am Med Womens Assoc. 2003;58(3):191–8.PubMed
6.
Davenport DL, Bowe EA, Henderson WG, Khuri SF, Mentzer Jr RM. National surgical quality improvement program (NSQIP) risk factors can be used to validate American society of anesthesiologists physical status classification (ASA PS) levels. Ann Surg. 2006;243(5):636–41. Accessed 4 June 2014.PubMedCentralPubMedCrossRef
7.
Mak PH, Campbell RC, Irwin MG, American Society of Anesthesiologists. The ASA physical status classification: Inter-observer consistency. American society of anesthesiologists. Anaesth Intensive Care. 2002;30(5):633–40.PubMed
8.
Revenig LM, Ogan K, Guzzo TJ, Canter DJ. The use of frailty as a surgical risk assessment tool in elderly patients. Curr Geriatr Rep. 2014;3(1):1–7.CrossRef
9.
Extermann M, Aapro M, Bernabei R, et al. Use of comprehensive geriatric assessment in older cancer patients: Recommendations from the task force on CGA of the international society of geriatric oncology (SIOG). Crit Rev Oncol. 2005;55(3):241–52.CrossRef
10.
Kim S, Han H, Jung H, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA surgery. 2014.
11.
Pope D, Ramesh H, Gennari R, et al. Pre-operative assessment of cancer in the elderly (PACE): A comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15(4):189–97.PubMedCrossRef
12.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMedCrossRef
13.••
Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8. The first large study using simple frailty measure as a predictor of postoperative complications.PubMedCrossRef
14.
15.
Moyer VA. Screening for prostate cancer: US preventive services task force recommendation statement. Ann Intern Med. 2012;157(2):120–34.PubMedCrossRef
16.
17.•
Drazer MW, Prasad SM, Huo D, et al. National trends in prostate cancer screening among older American men with limited 9‐year life expectancies: Evidence of an increased need for shared decision making. Cancer. 2014. Highlights the primary problem with PSA screening; its inappropriate use in very old men and those with limited life expectancies.
18.
Preventive US. Serv Task Force. Screening for prostate cancer: US preventive services task force recommendation statement. Ann Intern Med. 2008;149(3):185–91.CrossRef
19.
Walter LC, Bertenthal D, Lindquist K, Konety BR. PSA screening among elderly men with limited life expectancies. JAMA. 2006;296(19):2336–42.PubMedCrossRef
20.
Vellekoop A, Loeb S. The utility of prostate-specific antigen screening and prostate cancer treatment in elderly patients. Curr Transl Geriatr ExpGerontol Rep. 2013;2(2):51–7.CrossRef
21.
Mohler JL, Kantoff PW, Armstrong AJ, et al. Prostate cancer, version 2.2014. J Natl Compr Canc Netw. 2014;12(5):686–718.PubMed
22.
Daskivich TJ, Chamie K, Kwan L, et al. Comorbidity and competing risks for mortality in men with prostate cancer. Cancer. 2011;117(20):4642–50.PubMedCrossRef
23.
Scosyrev E, Messing E, Mohile S, Golijanin D, Wu G. Prostate cancer in the elderly: Frequency of advanced disease at presentation and disease-specific mortality. Int Braz j Urol. 2011;37(6):797–8.CrossRef
24.
Schwartz KL, Alibhai SM, Tomlinson G, Naglie G, Krahn MD. Continued undertreatment of older men with localized prostate cancer. Urology. 2003;62(5):860–5.PubMedCrossRef
25.
Droz J, Balducci L, Bolla M, et al. Management of prostate cancer in older men: Recommendations of a working group of the international society of geriatric oncology. BJU Int. 2010;106(4):462–9.PubMedCentralPubMedCrossRef
26.
Rice KR, Colombo ML, Wingate J, et al. Low risk prostate cancer in men more than 70 years old: To treat or not to treat. Urol Oncol. 2013;31(6):755–760.PubMedCrossRef
27.
Mitsuzuka K, Koie T, FAU - Narita S, et al. Are pathological and oncological outcomes of elderly men treated with radical prostatectomy worse than those of younger men? matched-pair analysis between patients aged =70 years. - Jpn J Clin Oncol.2014. (1465-3621 (Electronic); 0368-2811 (Linking)).
28.
29.
Rabbani F, Stapleton AM, Kattan MW, Wheeler TM, Scardino PT. Factors predicting recovery of erections after radical prostatectomy. J Urol. 2000;164(6):1929–34.PubMedCrossRef
30.
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358(12):1250–61.PubMedCrossRef
31.
Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346(15):1138–44.PubMedCrossRef
32.
Zeliadt SB, Potosky AL, Penson DF, Etzioni R. Survival benefit associated with adjuvant androgen deprivation therapy combined with radiotherapy for high-and low-risk patients with nonmetastatic prostate cancer. Int J Radiat Oncol Biol Phys. 2006;66(2):395–402.PubMedCrossRef
33.
Kunkler IH, Audisio R, Belkacemi Y, et al. Review of current best practice and priorities for research in radiation oncology for elderly patients with cancer: The international society of geriatric oncology (SIOG) task force. Ann Oncol. 2014. doi:10.​1093/​annonc/​mdu104.
34.
Studer UE, Collette L, Whelan P, et al. Using PSA to guide timing of androgen deprivation in patients with T0–4 N0–2 M0 prostate cancer not suitable for local curative treatment (EORTC 30891). Eur Urol. 2008;53(5):941–9.PubMedCrossRef
35.
Lebret T, Culine S, FAU - Davin J, et al. Quality of life of 1276 elderly patients with prostate cancer, starting treatment with a gonadotropin-releasing hormone agonist: Results of a french observational study. - Aging Male.2014 Feb 27. (1473-0790 (Electronic); 1368-5538 (Linking)).
36.
Schultzel M, Saltzstein SL, Downs TM, Shimasaki S, Sanders C, Sadler GR. Late age (85 years or older) peak incidence of bladder cancer. J Urol. 2008;179(4):1302–6.PubMedCentralPubMedCrossRef
37.
Hall MC, Chang SS, Dalbagni G, et al. Guideline for the management of nonmuscle invasive bladder cancer (stages ta, T1, and tis): 2007 update. J Urol. 2007;178(6):2314–30.PubMedCrossRef
38.
Mak RH, Zietman AL, Heney NM, Kaufman DS, Shipley WU. Bladder preservation: Optimizing radiotherapy and integrated treatment strategies. BJU Int. 2008;102(9b):1345–53.PubMedCrossRef
39.
Pietzak EJ, Drach GW, Malkowicz SB, Guzzo TJ. Optimal management of the elderly patient with muscle-invasive bladder cancer. Curr Transl Geriatr Exp Gerontol Rep. 2013;2(2):58–65.CrossRef
40.
Chamie K, Hu B, DeVere White RW, Ellison LM. Cystectomy in the elderly: Does the survival benefit in younger patients translate to the octogenarians? BJU Int. 2008;102(3):284–90.PubMedCrossRef
41.
Isbarn H, Jeldres C, Zini L, et al. A population based assessment of perioperative mortality after cystectomy for bladder cancer. J Urol. 2009;182(1):70–7.PubMedCrossRef
42.
Donat SM, Siegrist T, Cronin A, Savage C, Milowsky MI, Herr HW. Radical cystectomy in octogenarians—does morbidity outweigh the potential survival benefits? J Urol. 2010;183(6):2171–7.PubMedCrossRef
43.
Mendiola FP, Zorn KC, Gofrit ON, et al. Cystectomy in the ninth decade: Operative results and long-term survival outcomes. Can J Urol. 2007;14(4):3628–34.PubMed
44.
Hollenbeck BK, Miller DC, Taub D, et al. Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older. Urology. 2004;64(2):292–7.PubMedCrossRef
45.
Prout GR, Wesley MN, Yancik R, Ries LA, Havlik RJ, Edwards BK. Age and comorbidity impact surgical therapy in older bladder carcinoma patients. Cancer. 2005;104(8):1638–47.PubMedCrossRef
46.
Rink M, Dahlem R, Kluth L, et al. Older patients suffer from adverse histopathological features after radical cystectomy. Int J Urol. 2011;18(8):576–84.PubMedCrossRef
47.
Berneking AD, Rosevear HM, Askeland EJ, Newton MR, O'Donnell MA, Brown JA. Morbidity and mortality of octogenarians following open radical cystectomy using a standardized reporting system. Can J Urol. 2013;20(4):6826–31.PubMed
48.
Froehner M, Brausi MA, Herr HW, Muto G, Studer UE. Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol. 2009;56(3):443–54.PubMedCrossRef
49.
Liberman D, Lughezzani G, Sun M, et al. Perioperative mortality is significantly greater in septuagenarian and octogenarian patients treated with radical cystectomy for urothelial carcinoma of the bladder. Urology. 2011;77(3):660–6.PubMedCrossRef
50.
Lawrentschuk N, Colombo R, Hakenberg OW, et al. Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol. 2010;57(6):983–1001.PubMedCrossRef
51.
Richards KA, Kader AK, Otto R, Pettus JA, Smith III JJ, Hemal AK. Is robot-assisted radical cystectomy justified in the elderly? A comparison of robotic versus open radical cystectomy for bladder cancer in elderly ≥ 75 years old. J Endourol. 2012;26(10):1301–6.PubMedCrossRef
52.
53.
54.
55.
Lambert JW, Ingham M, Gibbs BB, Given RW, Lance RS, Riggs SB. Using preoperative albumin levels as a surrogate marker for outcomes after radical cystectomy for bladder cancer. Urology. 2013;81(3):587–92.PubMedCrossRef
56.
Van Kan GA, André E, Bischoff-Ferrari H, et al. Carla task force on sarcopenia: Propositions for clinical trials. JNHA- J Nutrit Health Aging. 2009;13(8):700–7.CrossRef
57.
Psutka SP, Carrasco A, Schmit GD, et al. Sarcopenia in patients with bladder cancer undergoing radical cystectomy: Impact on cancer‐specific and all‐cause mortality. Cancer. 2014;120(18):2910–8.PubMedCrossRef
58.
59.
Vale C. Neoadjuvant chemotherapy in invasive bladder cancer: Update of a systematic review and meta-analysis of individual patient data: Advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol. 2005;48(2):202–6.CrossRef
60.
Keegan KA, Zaid HB, Patel SG, Chang SS. Increasing utilization of neoadjuvant chemotherapy for muscle-invasive bladder cancer in the united states. Curr Urol Rep. 2014;15(4):1–5.CrossRef
61.
Galsky MD, Hahn NM, Rosenberg J, et al. A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol. 2011;12(3):211–4.PubMedCrossRef
62.••
Ploussard G, Daneshmand S, Efstathiou JA, et al. Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: A systematic review. Eur Urol. 2014;66(1):120–37. An excellent review article compiling all of the recent studies of bladder-sparing treatment for bladder cancer.
63.
Madersbacher S, Hochreiter W, Burkhard F, et al. Radical cystectomy for bladder cancer today–a homogeneous series without neoadjuvant therapy. J Clin Oncol. 2003;21(4):690–6.PubMedCrossRef
64.
Culp SH, Dickstein RJ, Grossman HB, et al. Refining patient selection for neoadjuvant chemotherapy before radical cystectomy. J Urol. 2014;191(1):40–7.PubMedCentralPubMedCrossRef
65.
Turgeon G, Souhami L, Cury FL, et al. Hypofractionated intensity modulated radiation therapy in combined modality treatment for bladder preservation in elderly patients with invasive bladder cancer. Int J Radiat Oncol Biol Phys. 2014;88(2):326–31. doi:10.​1016/​j.​ijrobp.​2013.​11.​005.PubMedCrossRef
66.
Wehrberger C, Berger I, Marszalek M, et al. Bladder preservation in octogenarians with invasive bladder cancer. Urology. 2010;75(2):370–5.PubMedCrossRef
67.
Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer. 2004;100(4):738–45.PubMedCrossRef
68.
69.
Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: A need to reassess treatment effect. J Natl Cancer Inst. 2006;98(18):1331–4.PubMedCrossRef
70.
Wagstaff P, Zondervan P, de la Rosette J, Laguna M. The role of imaging in the active surveillance of small renal masses. Curr Urol Rep. 2014;15(3):1–8.CrossRef
71.
Remzi M, Özsoy M, Klingler H, et al. Are small renal tumors harmless? analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol. 2006;176(3):896–9.PubMedCrossRef
72.
Crispen PL, Boorjian SA, Lohse CM, et al. Outcomes following partial nephrectomy by tumor size. J Urol. 2008;180(5):1912–7.PubMedCrossRef
73.
Lane BR, Abouassaly R, Gao T, et al. Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer. 2010;116(13):3119–26.PubMedCrossRef
74.•
Kutikov A, Egleston BL, Canter D, Smaldone MC, Wong Y, Uzzo RG. Competing risks of death in patients with localized renal cell carcinoma: A comorbidity based model. J Urol. 2012;188(6):2077–83. A useful nomogram to determine if a patient’s comorbidities provide enough of a competing risk to negate the benefit of nephrectomy.PubMedCrossRef
75.
Crispen PL, Viterbo R, Fox EB, Greenberg RE, Chen DY, Uzzo RG. Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer. 2008;112(5):1051–7.PubMedCrossRef
76.
Abouassaly R, Lane BR, Novick AC. Active surveillance of renal masses in elderly patients. J Urol. 2008;180(2):505–9.PubMedCrossRef
77.
Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DY, Uzzo RG. Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer. 2009;115(13):2844–52.PubMedCentralPubMedCrossRef
78.
Smaldone MC, Kutikov A, Egleston BL, et al. Small renal masses progressing to metastases under active surveillance. Cancer. 2012;118(4):997–1006.PubMedCrossRef
79.
Donat SM, Diaz M, Bishoff JT, et al. Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol. 2013;190(2):407–16.PubMedCrossRef
80.
Pierorazio PM, Hyams ES, Mullins JK, Allaf ME. Active surveillance for small renal masses. Rev Urol. 2012;14(1–2):13.PubMedCentralPubMed
81.
Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.PubMedCrossRef
82.
Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181(1):55–62.PubMedCentralPubMedCrossRef
83.
McKiernan J, Simmons R, Katz J, Russo P. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology. 2002;59(6):816–20.PubMedCrossRef
84.
Thompson RH, Boorjian SA, Lohse CM, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008;179(2):468–73.PubMedCrossRef
85.•
Sun M, Bianchi M, Trinh Q, et al. Comparison of partial vs radical nephrectomy with regard to other‐cause mortality in T1 renal cell carcinoma among patients aged≥ 75 years with multiple comorbidities. BJU Int. 2013;111(1):67–73. Emphasizes the importance of comorbidities in predicting mortality following radical and partial nephrectomy.PubMedCrossRef
86.
Simhan J, Smaldone MC, Tsai KJ, et al. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol. 2011;60(4):724–30.PubMedCentralPubMedCrossRef
87.
Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543–52.PubMedCrossRef
88.
Tomaszewski JJ, Uzzo RG, Kutikov A, et al. Assessing the burden of complications after surgery for clinically localized kidney cancer by age and comorbidity status. Urology. 2014;83(4):843–50.PubMedCrossRef
89.
Ficarra V, Minervini A, Antonelli A, et al. A multicenter Matched‐Pair analysis comparing Robot‐Assisted versus open partial nephrectomy. BJU Int. 2014;113(6):936–41.PubMedCrossRef
90.
Gill IS, Patil MB, de Castro Abreu AL, et al. Zero ischemia anatomical partial nephrectomy: A novel approach. J Urol. 2012;187(3):807–15.PubMedCrossRef
91.
Gunn AJ, Gervais DA. Percutaneous ablation of the small renal mass—techniques and outcomes. Semin Intervent Radiol. 2014;31(01):033–041.CrossRef
92.
Olweny EO, Park SK, Tan YK, Best SL, Trimmer C, Cadeddu JA. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: Comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol. 2012;61(6):1156–61.PubMedCrossRef
Metadata
Title
Evaluation and Management of the Geriatric Urologic Oncology Patient
Authors
Maxim J. McKibben
Angela B. Smith
Publication date
01-03-2015
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 1/2015
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-014-0106-5

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