Senior Citizens’ Problems Specialist Consultation
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Due to increasing life expectancy and the introduction of prostate-specific antigen (PSA) screening, a rising number of elderly men are diagnosed with prostate cancer. Besides PSA serum levels and Gleason score, age is considered to be a key prognostic factor in terms of treatment decisions. In men older than 70 years, treatment without curative intent may deprive the frail patient of years of life. Modern radical prostatectomy techniques are associated with low preoperative morbidity, excellent clinical outcome, and documented long-term disease control. Thus, radical prostatectomy should be considered because local treatment of organ-confined prostate cancer potentially cures disease. The huge extent of PSA screening programs may lead to over diagnosis of prostate cancer. Not every man who is diagnosed with prostate cancer will develop clinically significant disease. This has led to the concept of expectant management for screen-detected, small-volume, low-grade disease, with the intention of providing therapy for those men with disease progression.
 
 
Prostate cancer is a common cancer among men after the age of 65. Symptoms of cancer initially are similar to those caused by BPH. Untreated cancer spreads to all parts of the body leading to pain, discomfort and ultimately death. Regular check-up by rectal examination is the best method of detecting prostate cancer early and in curable stages before symptoms appear. Definitive diagnosis of prostatic cancer necessitates a biopsy (simple surgical procedure in which a small piece of the prostate tissue is removed with a needle and examined under a microscope). In the event of a positive result, further investigations are required to determine the extent of the spread of the disease. Surgery, hormone therapy and radiotherapy are the different methods of treatment for prostate cancer. The result of surgery however depends on the stage of the disease. The best protection against prostate problems is to have regular medical check-ups that should include a rectal examination of the prostate. See your doctor promptly if symptoms such as a frequent urge to urinate, difficulty in urinating, or dribbling occurs. Waiting until severe symptoms appear may result in serious and sometimes life-threatening complications.
 
 
Prostate cancer is the most common malignancy among elderly men and is the second leading malignancy in the Western world. The incidence of prostate cancer has steadily increased over the last decade. Between 2000 and 2050, the number of men over 65 years is expected to increase 4-fold worldwide. By 2030, the percentage of men older than 65 years will rise to 19.6% of the population compared with 12.4% population in 2000.  Thus, the percentage of men who will be diagnosed with prostate cancer and those who will require treatment for their malignancy will rise in the coming years. A rising incidence of microscopic foci of prostate cancer is found in men with increasing age. Results of autopsy studies have shown that almost 30% of men over the age of 50 have histological evidence of prostate cancer. More and more prostate cancers are also diagnosed in younger men who want treatment that does not compromise their quality of life, take time away from work, or cause worrisome side effects. Laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy, and third-generation cryotherapy are promising new treatment options for men diagnosed with prostate cancer.

Although a majority of prostate cancer patients will develop microscopic disease with increasing age, only a few of these patients will experience invasive prostate cancer. Due to its indolent course and the fact that the majority of patients are diagnosed early, disease progression often occurs many years after the initial diagnosis. Elderly men who have concurrent severe comorbidities may not experience progression to metastatic stage during their lifetimes. Androgen deprivation therapy is effective for treating prostate cancer, but patients can often experience significant side effects. These complications need to be recognized and managed properly in order to minimize adverse effects and loss of patients’ quality of life. To choose the right treatment option, clinicians need to determine whether patients are at high or low risk for disease progression and invasive forms of prostate cancer.

The incidence of deaths from prostate cancer has decreased over the last decade, probably as a result of improved screening and diagnosis, improved treatments, and better risk assessment to guide therapy. Moderate incidence increases in the last decade are most likely attributable to widespread PSA screening among men younger than 65 years. Prostate cancer incidence rates have levelled off in men aged 65 years and older.