[Geriatric assessments and their practical application in uro-oncology : How do we decide on prostate cancer treatment in an age-appropriate way?]

Abstract

The management of geriatric patients with urological cancers is becoming increasingly important due to rising life expectancy and the growing incidence of such diseases. However, treatment decisions are often based primarily on chronological age or clinical guidelines, whilst insufficient consideration is given to the functional reserve of older patients. Geriatric patients exhibit specific physiological changes such as impaired renal or liver function, sarcopenia, multimorbidity, polypharmacy, malnutrition and cognitive impairments, which increase the risk of postoperative complications, functional decline, delirium, falls and the need for care. Standard therapies can therefore lead to significant functional limitations despite their oncological benefits. The aim of modern uro-oncological treatment is not only to prolong life but, in particular, to preserve autonomy, mobility and quality of life. For the purpose of individualised treatment planning, current guidelines recommend a stepwise geriatric assessment. This begins with screening using the G8 and mini-COG©, followed by a simplified geriatric assessment or a comprehensive geriatric assessment (CGA) if any abnormalities are detected. Classifying patients as fit, vulnerable or frail enables risk-adapted treatment decisions and targeted geriatric interventions. This can improve functional reserves, reduce complications and potentially avoid the need for long-term care.