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Chemotherapy for Prostate Cancer in Senior AdultsTherefore, there is a clear need to better define how to treat elderly or frail patients with PCa, as they constitute such a large proportion of the patient population. From a clinical perspective, age is highly heterogeneous and poorly reflected by chronological age. Although ageing can be associated with changes that might affect how chemotherapy acts, it is not a barrier to chemotherapy per se and is not in itself a contraindication to standard-regimen chemotherapy. Chemotherapy decisions in patients with advanced PCa are complex and involve consideration of several factors apart from age, including the clinical disease status, life expectancy, comorbidity, and functional status. When considering chemotherapy, decisions must be based not on age but with at least one of the available screening tools of vulnerability and frailty. However, clinical trials still evaluate chemotherapy in the elderly based on age, and no clinical trials have specifically addressed the strategy of geriatric assessment. Trials often have not only stringent exclusion criteria relating to age but also to comorbidities and concomitant therapies. Few studies have investigated the efficacy and safety of chemotherapy in elderly men with HRPC. Initial phase 2 trials showed there was a similar incidence of nonhaematologic adverse events in both younger and older patients. Older patients were, however, more sensitive to docetaxel-induced neutropenia, which is attributed to a declining bone marrow reserve with age. Nowadays, good news is coming for senior adults with PCa. Less toxic oral compounds, such as new targeted strategies like irreversible inhibitors of CYP17 (P450c17), inhibitors of 17a-hydroxylase and c17, 20-lyase (abiraterone), and highly potent inhibitors of the androgen receptor (AR) MDV3100, which inhibits AR function by blocking nuclear translocation, DNA binding , have now shown signs of promising efficacy with a good tolerability profile. Activity of these compounds has been demonstrated even in patients failing docetaxel. Those compounds might have a suitable place either combined with or instead of chemotherapy NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment. |
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