Prostate cancer in the elderly

The article was written by Internal Oncologist - Internal Oncology Department - Vinmec Times City International General Hospital.

With an exponential population aging rate and increasing life expectancy, especially in developing countries, the burden of prostate cancer in the elderly is projected to increase sharply in the future.

The growing number of elderly patients is increasingly being recognized as a necessary priority by the oncology community. As the most common cancer in men in developed countries, prostate cancer affects a sizable portion of elderly men. Prostate cancer mainly affects older men (≥70 years of age). Median age at diagnosis was 68 years, two-thirds of prostate cancer-related deaths occurred in men 75 years of age and was the second most common cause of cancer death in this group. .
About a third of prostate cancer diagnoses are in patients over 75 years of age. Prostate cancer usually grows slowly, and about 90% of patients are alive five years after being diagnosed. Prostate cancer is often latent, with no symptoms, in approximately 60% of men over the age of 80.

Blood test: (Prostate Specific Antigen (PSA) test): Results show an increase in PSA in prostate cancer. However, a high PSA test result does not necessarily mean cancer. Other diseases of the prostate gland that are not cancerous can also cause PSA levels that are higher than normal such as: Prostatitis, enlarged prostate...
Rectal examination with finger: Prostate may During a rectal exam, the doctor examines the patient using a lubricated gloved finger to check the size of the prostate gland and assess for any abnormalities. Evaluation of prostate cancer in the elderly is grouped into several conditions, including physical health (eg, comorbidities, nutritional status), mental health (eg, depression, cognitive impairment), functional health (eg, specific activities of daily living), symptoms (eg, pain, dyspnea), and social health (eg, supportive care care, social networks..)
If the patient is likely to have prostate cancer, the doctor will order a prostate biopsy. Biopsy is the only way to definitively diagnose cancer. The doctor removes small tissue samples from the prostate using small, hollow biopsy needles that, guided by ultrasound, approach the prostate through the rectum (transrectal) or perineum (transperineal). The tissue is sent to a pathologist to find out if the cells are malignant (cancerous) or benign (non-cancerous).

Treatment decisions for elderly patients with prostate cancer should consider the patient's fitness for treatment, assess the malignancy of the cancer, and discuss the patient's wishes and expectations. core. Comorbidities and the patient's tolerance for treatment-related side effects. Anti-androgen hormone therapy is the mainstay of treatment for patients with metastatic prostate cancer. Surgical orchiectomy and LHRH agonist orchiectomy are the standard for first-line treatment. Metastatic prostate cancer is treated with hormone therapy, which can stop the growth of the disease, relieve symptoms, and keep the cancer from spreading to the bone without pain for a long time. Hormone therapy is unlikely to cause sudden and severe harm, but may be associated with osteoporosis, sweating, loss of muscle tone, and an increased risk of cardiovascular disease. Chemotherapy treatments require the patient to be in good general condition, so they are not suitable for the elderly or patients with multiple medical conditions.
If the cancer is confined to the prostate gland and has not spread further, surgery or local radiation therapy is the treatment. The way surgery and the technique of performing radiation therapy have evolved, significantly reducing the serious complications they cause, such as those related to urinary and gastrointestinal function. Surgery is also an important treatment, but it requires the patient to be in good general condition and therefore radiation therapy is often chosen to treat elderly patients.
Prostate cancer is often diagnosed in elderly patients and is often detected at the metastatic stage. Choosing the right treatment method for the health of elderly patients, who may have other comorbidities, is very important. Ensuring safety, minimizing complications, and focusing on the patient's quality of life is a top priority.
Robotic surgery has been deployed in many major hospitals around the world and is gradually becoming a surgical trend in the world. To achieve optimal surgical efficiency, Vinmec Times City Hospital has equipped the Da Vinci Robot made in the United States with a sophisticated and modern structure. The robot has 4 arms that almost perfectly simulate human hand movements, but the rotation angle can be doubled up to nearly 540 degrees of rotation. The robot can eliminate hand tremors, shaking movements, meeting the needs of surgery and microsurgery that need high precision. The 3D lens magnifies the surgical sites by 10 times. Thanks to this feature, surgical robots can penetrate hard-to-reach places, "resolve" the limitations of traditional surgery, especially highly effective when treating prostate cancer, digestive tract. . Robotic surgery center is one of many steps of Vinmec Medical System, aiming to turn Vinmec Times City into a leading modern and comprehensive surgical center in Vietnam. Vinmec is successfully combining traditional surgical treatment (open surgery) and high technology (laparoscopic surgery, robotic surgery...), effectively helping to treat complex diseases.