EURURO Vol. 72 No. 4

532 656

Platinum Priority – Editorial
Referring to the article published on pp. 521–531 of this issue
Prostate Cancer Management in an Ageing Population
Jeremy P. Grummet Karin Plass James N’Dow
a Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; bEuropean Association of Urology, Guidelines Office, Arnhem,
The Netherlands; c Academic Urology Unit, University of Aberdeen, Aberdeen, UK; d Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
We are all aware of the world’s ageing population, a trend
that is set to continue for decades ahead. The United Nations
2015 revision of their World Population Prospects report
predicts that ‘‘globally, the number of persons aged 80 or
over is projected to increase from 125 million in 2015 to
434 million in 2050’’ representing a more than threefold
increase. The number of people aged 65 yr in the European
Union is expected to grow from approximately 84 million in
2008 to 141 million by 2050 We are also well aware
that prostate cancer is a disease for which incidence
increases with age. This combination means that prostate
cancer among older men will represent an ever-increasing
massive disease burden.
It is therefore critical that the issue of how to manage
prostate cancer in older men is properly addressed. Many fit
and healthy older men are at risk of undertreatment
because of an underestimation of their longevity, but others
are equally at risk of overtreatment when comorbidities
that predict a greater health risk than their prostate cancer
are not taken into account.
In this issue of European Urology, Droz et al present a
clinically practical update on the International Society of
Geriatric Oncology (SIOG) guidelines for prostate cancer in
men aged >70 yr. Previous SIOG guidelines on prostate
cancer management for older men have been endorsed by
the European Association of Urology (EAU) and are
incorporated in Section 6.7 of the EAU prostate cancer
guidelines, which are freely available online.
Perhaps the most important addition to these updated
guidelines is the recommendation for cognitive function
screening in this age group via the mini-COG test. This
screening test is similar in diagnostic performance to the
Mini Mental State Examination (MMSE) but is far less time-
consuming. Patients scoring<3 out of 5 require referral for a
full assessment for dementia.
The updated guidelines also provide practical tools for
evaluation of overall health status that could be realistically
performed in the clinic. Like the mini-COG test, G8
screening takes just 5 min to conduct, and for the G8 test
a score of <15 out of 17 is considered abnormal. The G8
screening test has the dual purpose of determining if
referral for a comprehensive geriatric assessment (CGA) is
needed to identify possible reversible conditions, and of
subsequently helping to choose the most appropriate
management of the patient’s prostate cancer. Both the G8
and mini-COG tests are provided for use in the article.
Notwithstanding the immense clinical utility of these
recommendations, it should be remembered that they are
based on informal expert consensus only, underpinned by a
traditional narrative review of the evidence rather than a
formal, robust, systematic review.
Furthermore, the authors make clear that there are large
gaps in knowledge in this area. Examples cited include
validation of G8 screening in this patient population and
nomograms to predict outcomes when using health status
assessment tools. However, it is notable that little mention is
made of focal therapy for localised disease. Perhaps the older
age group, for which trade-offs between cancer morbidity
and treatment morbidity are arguably even tighter than for
younger patients, would be ideally suited for further study of
the role of focal therapy in their management care pathway.
In our exponentially ageing population, the field of
prostate cancer management among older men is ripe for
vigorous prospective clinical research. Until these research
questions are answered, the updated guidelines should
serve as a timely and highly practical clinical tool.
available at
journal homepage:
DOI of original article: .
* Corresponding author. Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia. Tel. +61 293 628644;
Fax: +61 293 621433.
E-mail address: (J.P. Grummet).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.