Special Report: Tailoring prostate cancer care for older adults

In this Special Report from Urology Times®, Michael S. Cookson, MD, MMHC, FACS, and Kelly L. Stratton, MD, FACS, discuss treatment planning for prostate cancer, particularly in older patients. Cookson highlights the need for a comprehensive and individualized approach that goes beyond chronological age. He emphasizes that decisions about therapy must account for a patient’s overall baseline health, including their frailty, cognitive function, and the presence or absence of a support system. These factors are essential in determining a patient’s ability to tolerate and benefit from treatment, especially as all available therapies carry potential adverse events and risks.

A critical concern in this population is bone health. Androgen deprivation therapy exacerbates the risk of skeletal-related events. Older men already face an elevated risk of fractures, particularly hip fractures, which can occur independently of cancer progression. Therefore, evaluating bone density and considering the use of bone-protective agents are vital components of the treatment plan.

Cookson also stresses the importance of monitoring and managing cardiovascular health. Hormonal therapies used in prostate cancer can negatively impact metabolic profiles, including increasing lipid levels and other cardiovascular risks. As such, baseline and ongoing assessment of heart health is essential, especially in patients with pre-existing cardiac issues.

Additional aspects of care may include nutritional support and genetic counseling, further underscoring the need for a multidisciplinary approach. These considerations help mitigate treatment complications and ensure that patients receive the most appropriate and supportive care possible throughout their cancer journey.

Despite these complexities, Cookson makes clear that age alone should not be a limiting factor in offering effective therapies. Rather, the focus should be on functional status, comorbidities, and individual preferences, enabling clinicians to tailor treatment plans that maximize benefit while minimizing harm in an older patient population.

Our panelists:

Michael S. Cookson, MD, MMHC, FACS, is a professor and the Donald D. Albers Endowed Chair in Urology at the University of Oklahoma Health Sciences Center in Oklahoma City. He is also a Co–Editor in Chief for Urology Times®.

Kelly L. Stratton, MD, FACS, is an assistant professor of urologic oncology and an adjunct associate professor of medicine at the University of Oklahoma (OU) College of Medicine and the chair of urologic oncology at the OU Stephenson Cancer Center in Oklahoma City. He is also a member of the Urology Times Editorial Council.