Treatment of Elderly Patients with High-Risk Prostate Cancer

Initial Treatment Recommendations

The National Comprehensive Cancer Network recommends radiation therapy (EBRT) combined with 24-36 months of androgen deprivation therapy (ADT) for elderly patients with high-risk prostate cancer (Gleason 9), with consideration of shorter-course ADT (4-6 months) if the patient has moderate-to-severe comorbidities 1, 2
For fit elderly patients, the American Urological Association recommends external beam radiation therapy (EBRT) with long-term ADT (24-36 months) as the primary treatment option 1, 3

The National Comprehensive Cancer Network suggests that shorter-course ADT (4-6 months) combined with radiation therapy is the preferred approach for patients with moderate-to-severe comorbidities 2, 7, 8
The European Association of Urology recommends that the decision to shorten ADT duration should be based on specific comorbidity assessment, not age alone 2, 9

The National Comprehensive Cancer Network recommends bone health monitoring due to increased fracture risk in elderly patients receiving ADT 2, 7, 8
The American Society of Clinical Oncology suggests that prophylactic breast irradiation (8-15 Gy in 1-3 fractions) should be given 1-2 weeks before initiating antiandrogen therapy to prevent painful gynecomastia 6

The National Comprehensive Cancer Network recommends docetaxel chemotherapy (75 mg/m² every 3 weeks) plus prednisone as the standard treatment for castration-resistant prostate cancer 7, 8, 5
The European Association of Urology suggests that growth factor support should be considered in patients ≥65 years to decrease neutropenic complications 2, 7, 8

The National Comprehensive Cancer Network recommends PSA measurement every 3 months during year 1, then every 6 months, and digital rectal examination at follow-up visits 3, 4
The American Urological Association suggests that bone scan and imaging should be performed if PSA rises or symptoms develop 11, 6