RP in Elderly over 75 Yrs

• 06 Dec 2021 09:05:10 AM
• |Onco Urology

Dear All,

RP in elderly men over 75 is a controversial Issue not yet resolved. The standard Teaching is that RP can be offered for those with a likely 10 Yrs or more life. We were using various performance scales like ECOG/Karnofsky. But since 2005, Geriatric Oncology has brought out a G8 Scale for assessing the performance status of Patients with Cancer over 75 Yrs of age. G8 is a geriatric screening tool designed to identify elderly cancer patients who benefit from a comprehensive geriatric assessment (CGA). Based on a multicentre prospective cohort the G8 (8 items; range 0 [poor] to 17 [good prognosis]). Results suggested 14 as threshold, equivalent to 90% sensitivity, and 60% specificity. In fact the G8 scoring system employed is more comprehensive and to use it for calculation on a routine basis is difficult. Claudia Martinez-Tapia, Etienne Audureau* (2016) brought out a simplified version with 6 items taken into consideration and it has been validated and shows good discrimination. The link of the article is provided which is well worth a read.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746091/pdf/theoncologist_15326.pdf

In an article by Philipp Mandel, Thennappan Chandrasekar, Derya Tilki* et al (2019) mention that Biological age alone should not be taken into consideration as contraindication. The average life expectancy of a 75-year-old American man is 11.2 years, while Y Kumar et al (2019) found that it is 9.2 years for Indian men of the same age group. Many men over 75 Yrs of age show reasonable functional and oncologic outcomes. However, a health screening in all elderly patients before RP is mandatory. They noted that elderly patients with P Ca harbour notably worse tumour characteristics. Perioperative morbidity and mortality is increased in elderly patients, so patient selection according to comorbidities is an important issue that needs to be addressed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337955/pdf/AJA-21-32.pdf

Danny Darlington Carbin, Gagan Gautam* et al (2021 published online on 29^th Aug) has brought out an article on ‘RARP in Indian Men over 75 Propensity Score Matched Analysis’.

https://link.springer.com/content/pdf/10.1007/s11701-021-01301-9.pdf 

They conclude by stating that the perioperative, oncological and functional outcomes of elderly men undergoing RARP are not significantly different from that of their younger counterparts. This underlines the fact that RARP is a safe procedure even in older men. It is safe and prudent to offer RARP for men ≥ 75 years of age with reasonable life expectancy and good performance status.

The article is worth a read and understanding.

With warm Regards,

Venu