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Screening with G8 has two principal aims: to decide if a
CGA is needed to identify reversible conditions that can be
addressed by geriatric interventions integrated into the
cancer treatment plan
[14,15]; and to aid in choosing
appropriate prostate cancer treatment (see below).
2.2.
Cognitive screening
The task force considered that cognitive evaluation was
mandatory to assess the patient’s capacity to evaluate
information and make informed decisions. This represents
an addition to previous guidelines, and one that is likely to
assume increasing importance. A recent meta-analysis
compared the validity of cognitive screening tools
[16]. The authors identified 102 studies that used the
Mini Mental State Examination (MMSE). However, this is
time-consuming to complete. Of ten alternative tests, the
mini-COG
[4_TD$DIFF]
TM
[12]had a diagnostic performance that most
closely matched that of the MMSE, and was chosen. A cutoff
point of 3/5 indicates a need to refer the patient for full
evaluation of potential dementia
( Table 2).
2.3.
Simplified geriatric evaluation
Patients with an abnormal G8 score ( 14/17) should have a
simplified geriatric evaluation
( Table 3 ). This consists of the
ADL measure of dependence, the CIRS-G to assess comor-
bidities, and weight loss as an indication of malnutrition.
This may determine firstly whether specific geriatric
interventions are needed, and secondly whether a full
CGA is required.
2.3.1.
Dependence
Dependence is typically evaluated using the ADL scale
[17,18]. The presence of one ADL impairment—with the
exception of incontinence—is considered abnormal
[2] .The
presence of more than two ADL impairments is unlikely to
be reversible.
2.3.2.
Comorbidities
The CISR-G
[11]is a good tool for assessing the risk of non–
prostate cancer death
[2,11]. The CIRS-G, which rates
nonfatal conditions according to their severity and degree of
control by treatment, is subjective but practical
[19]. The
task force judged that geriatric interventions following a
CGA are likely to reverse grade 2 comorbidities. Single grade
3 comorbidities are generally irreversible, but need to be
individually evaluated. Grade 4 comorbidities are, by
definition, irreversible.
2.3.3.
Nutritional status
Malnutrition increases mortality in elderly patients
[20]but, unless severe, may be reversible via geriatric interven-
tion. The task force decided to screen for malnutrition using
weight loss during the last three months. Good nutritional
status is defined as
<
5% loss; risk of malnutrition as loss
between 5% and 10%; and severe malnutrition as weight
loss
>
10%.
3.
Categorisation of patients and implications for
treatment
It is generally argued that candidates for definitive therapy
for localised prostate cancer should have a life expectancy of
10 yr. In metastatic castration-resistant prostate cancer
(mCRPC) it is important to assess 2-yr and 5-yr survival.
Available tools can predict 1-yr or 5-yr survival for patients
living at home or in hospital or nursing home settings
[21],
but no classification or prognostic model based on health
status has been validated in urologic oncology. Recent
Table 1 – G8 screening tool
[5_TD$DIFF]
. According to 2014 Soubeyran et al.
[13]A. Has food intake declined over the past 3 mo due to loss of appetite,
digestive problems, chewing, or swallowing difficulties?
Severe decrease in food intake
0
Moderate decrease in food intake
1
No decrease in food intake
2
B. Weight loss during the last 3 mo?
Weight loss
>
3 kg
0
Does not know
1
Weight loss 1–3 kg
2
No weight loss
3
C. Mobility
Bed- or chair-bound
0
Able to get out of bed/chair but does not go out
1
Goes out
2
D. Neuropsychological problems?
Severe depression or dementia
0
Mild dementia
1
No psychological problems
2
E. Body mass index (BMI)?
BMI
<
19 kg/m
2
0
BMI 19 to
<
21 kg/m
2
1
BMI 21 to
<
23 kg/m
2
2
BMI 23 kg/m
2
3
F. Takes more than 3 prescription drugs per day?
Yes
0
No
1
G. In comparison to other people of the same age, how does the
patient consider his health status?
Not as good
0
Does not know
0.5
As good
1
Better
2
H. Age
86 yr
0
80–85 yr
1
<
80 yr
2
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 5 2 1 – 5 3 1
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