| Management of localized prostate cancer in older patients |
- Prostate cancer risk should be based on the D'Amico classification. (Unchanged)
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- Fit older patients with a chance of living >10 years with prostate cancer in the D'Amico high-risk group are most likely to benefit from treatment with curative intent. (Unchanged)
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- Older patients with prostate cancer at D'Amico low to intermediate risk are likely to benefit from active surveillance or watchful waiting, based on their individual expected survival. A curative approach must be discussed with intermediate-risk patients who have at least 10 years of life expectancy. (Modified)
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- The balance of benefits and harms of ADT for localized prostate cancer should be carefully assessed. Note the increased risk of diabetes, cardiovascular complications, osteoporosis, bone fractures, and cognitive dysfunction. Adjuvant ADT should only be used in intermediate- and, particularly, high-risk disease. With patients who are either symptomatic or asymptomatic but at D'Amico high risk, discuss ADT monotherapy only with those unwilling or unable to receive any form of local treatment. (Modified)
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- A validated tool such as the Schonberg or Lee Index can aid in predicting life expectancy independent of prostate cancer. (New)
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