Introduction

There is increasing evidence that older men with prostate cancer (aged over 70 years old) are under-treated. The International Society of Geriatric Oncology developed treatment guidelines to reduce ageism within prostate cancer care. Individual health status, not age, is recommended to drive decision-making for management, with the use of a validated screening instrument (G8) and the assessment of patients’ co-morbidities, dependence status and nutritional status. We aim to report the factors that affect decision-making for radical prostate cancer surgery in elderly patients with prostate cancer.

Patients and methods

A survey was sent out to all 48 specialist multi-disciplinary teams (sMDTs) within England and all four in Wales. sMDT leads were asked to rank six factors in order of importance (1=most important; 6=least important) when assessing an elderly patient’s suitability for radical surgery: age, expected life-expectancy, co-morbidities, performance status, cardio-pulmonary exercise test (CPEX) result and other.

Results

There was a 100% response rate from sMDT leads. 63% of sMDTs ranked expected life-expectancy as the most important factor, followed by co-morbidities (42%), performance status (40%), CPEX result (26%), and age (6%). Other factors flagged as important included patient choice and disease grade/status.

Conclusion

Chronological age is not regarded as the most important measure of suitability for radical prostate surgery. Clinicians should be encouraged to utilise validated tools to predict life expectancy and performance status when evaluating patient suitability for radical prostate cancer surgery.