Management of Advanced Prostate Cancer in Senior Adults: The New Landscape

Abstract

The landscape of treatment for advanced prostate cancer is continually evolving as new therapies are developed and guidelines are constantly updated. However, the management of older men with advanced disease is not optimal. Many men are denied chemotherapy based on their chronological age, not their health status. Androgen-deprivation therapy (ADT) remains the mainstay of first-line treatment of advanced disease. Once the disease becomes resistant to castration, docetaxel-based chemotherapy is the regulatory-approved standard of care, irrespective of age. The place of weekly docetaxel in patients with poor performance status and signs of frailty has to be further evaluated in clinical studies. New treatments are now available, or on the horizon, for disease that progresses during or after docetaxel therapy. Cabazitaxel and abiraterone have been shown to prolong survival, irrespective of age, and are already in clinical use having received regulatory approval. The optimal sequence for these two agents is still unknown, although there is some indication that in patients predicted to be poor responders to abiraterone (high Gleason score, progression during docetaxel therapy, rapid progression to castrateresistant prostate cancer with ADT) cabazitaxel should be the preferred choice. Further advances are being investigated, with promising data reported from phase III trials. The Oncologist 2012;17(suppl 1): 16 -22

Population-based study on use of chemotherapy in men with castration resistant prostate cancer

“…Many men with CRPC are old, however, healthy old men have similar treatment outcomes as younger men [29,30] and old men are equally motivated to receive chemotherapy for a survival benefit [31]. Treatment decisions should be made on the basis of biological age and comorbidity, a key predictor of life expectancy.…”

Preclinical Evaluation of the Supercritical Extract of Azadirachta Indica (Neem) Leaves In Vitro and In Vivo on Inhibition of Prostate Cancer Tumor Growth

“…Tumor development and progression involve multiple cellular processes, including cell transformation, deregulation of programmatic cell death, proliferation, invasion, angio-genesis, and metastasis (2). Targeting a single molecule for the treatment of cancer has shown limited promise because of the diversity of deregulated pathways in cancer (3). The initial effect of the drugs currently approved by the U.S. Food and Drug Administration (e.g., abiraterone and docetaxel) for castrate-resistant stage after the failure of androgen deprivation controls disease, but many of these therapies are short lived (4, 5).…”

Clinical Therapy of Metastatic Spinal Tumors

“…Use of estrogen receptor inhibitors (e.g., tamoxifen) and selective estrogen receptor downregulators (e.g., fulvestrant) is feasible for the treatment of breast cancer (86). With regard to prostate cancer, androgen deprivation therapy is widely accepted as the palliative treatment of choice (87).…”