Background: Prostatic cancer (PCa) is the most common cancer in men in Germany. The goal of this review is to define the indication for hormonal treatment in patients over age 70.
Methods: A selective search of the literature up to 2008 for the terms "prostate cancer", "androgen suppression and deprivation", "hormone therapy", "LHRH analogs", "antiandrogens", "active surveillance", and "watchful waiting" was performed in the Medline and Cochrane databases. The guidelines of the American Society of Clinical Oncology (ASCO, 2007) and the European Society of Urology (EAU, 2008) were also taken into account.
Results: Hormonal therapy is not indicated for patients with organ-confined, well-differentiated or moderately differentiated tumors who are otherwise in good health. It is beneficial in the treatment of locally advanced cancer with an unfavorable Gleason score. For patients with organ-confined cancers who are in poor general condition, hormonal therapy is deferred until symptoms arise. The guidelines recommend hormonal therapy in case of PSA elevations greater than 1.5 ng/mL after attempted curative treatment. Symptomatic metastases require immediate hormonal therapy. Intermittent androgen deprivation is an attractive alternative.
Conclusions: In patients over age 70, an attempt at curative treatment is only reasonable if the life expectancy exceeds 10 years. Hormonal therapy is the treatment of choice for patients with undifferentiated, locally advanced prostate cancer, recurrences as defined by PSA elevation, and symptomatic metastases.
Keywords: PSA testing; geriatric medicine; hormonal therapy; prostate cancer; surveillance.