Prostate Cancer Diagnosis and Treatment in Elderly Patients: Insights from a Cross-Sectional Survey

Strategic Insights -

Research conducted in Northeast Italy has provided valuable insights into the diagnosis and management of prostate cancer (PCa) in patients aged 75 years and older. The study, conducted by the Gruppo Uro-Oncologico del Nord-Est (GUONE), involved 104 physicians from various specialties and aimed to assess current clinical practices and experiences in diagnosing and managing elderly patients with PCa. The survey revealed diverse opinions on optimal diagnostic and therapeutic strategies for elderly patients, with varying recommendations for digital rectal exam, PSA testing, prostate biopsy, and other treatments.

Key Takeaways:

  • 35.9% of physicians recommended digital rectal exam for patients aged 75 or older at risk of PCa.
  • 76.3% of physicians continued PSA testing in patients aged 75 or older.
  • 36.5% of physicians believed that there should be no age limit for prostate biopsy.
  • 42.6% of physicians recommended MRI-guided prostate biopsy regardless of age.
  • 57.7% of participants deemed prostate biopsy mandatory before initiating any form of hormonal therapy.
  • 52% of physicians did not recommend PET/CT as a staging tool for patients older than 85 years.
  • 58.6% of physicians favored considering radical prostatectomy (RP) for patients without comorbidities up to the age of 75.
  • Chemotherapy had an age limit for 81.6% of respondents, with 18.4%, 22.5%, and 26.5% of physicians recommending age limits of 75, 80, and 85 years, respectively.
  • The use of androgen receptor pathway inhibitors (ARPIs) had no definitive age limits for 46.5% of respondents.
  • The preferred option for patients with no comorbidities and low-volume metastatic PCa was androgen deprivation therapy + ARPIs + RT.
  • The follow-up schedule after RP or RT exhibited heterogeneity with no consensus regarding the frequency of PSA testing or the age at which it should be discontinued.

Statistics:

  • 104 physicians participated in the survey between 1 November 2024 and 30 November 2024.
  • 51 questions were evaluated in the survey.
  • 35.9% of physicians recommended digital rectal exam for patients aged 75 or older at risk of PCa.
  • 76.3% of physicians continued PSA testing in patients aged 75 or older.
  • 81.6% of respondents believed that chemotherapy had an age limit.
  • 58.6% of physicians favored considering radical prostatectomy (RP) for patients without comorbidities up to the age of 75.

Sources:

  • Prostate Cancer Diagnosis and Treatment in Elderly Patients: A Cross-Sectional Survey Exploring Practice Patterns and Preferences of Uro-Oncologists in Northeast Italy. Diagnostics, 2025,15(9):1100.
  • University of Padua, Padua, Italy.
  • Filippo Carletti, Urology Clinic, Department of Surgery Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy.
  • MDPI AG (publisher for Diagnostics).