Resumen

PINA, Francisco Madeira; LUNET, Nuno  y  DIAS, Manuel Macedo. Prostate cancer and aging . Arq Med [online]. 2006, vol.20, n.5-6, pp.153-160. ISSN 2183-2447.

Aging is accompanied by progressive changes in hormones, cytokines and growth factors, some of them probably beneficial and others being associated with a higher risk of death by cardiovascular and oncological causes. Androgen replacement therapy in the elderly is becoming more frequent and is being used for longer periods, but the doubt remains regarding its impact in the risk of prostate cancer. Our experience from incident cases of prostate cancer shows that the proportion of patients presenting worse prognostic factors for relapse or progression (higher basal PSA, risk of bone metastasis, tumours with worse histological differentiation grade) increases with age. While chemo-endocrine primary prevention waits for the results from ongoing studies (e.g. 5α-reductase inhibitors, selenium, vitamin E), secondary prevention, based on the partial results from large international studies and the expansion of measures for early diagnosis (digital rectal examination and PSA), takes the lead with the generalization of radical therapies. According to our 15-year experience of radical prostatectomy, the group of elderly patients (>65 years) represents half the subjects eligible for this treatment, has a higher proportion of subjects with a Gleason score ≥ 7 or classified in the groups of higher risk of recurrence or progression. The risks and benefits to be expected from the different forms of hormonotherapy, integrated in tertiary prevention, as adjuvant of radical therapies, as palliative in patients in biochemical relapse, or in the context of palliative primary treatment, need to be evaluated at an individual level.

Palabras clave : prostate cancer; epidemiology; aging; prevention; androgen replacement therapy; hormonotherapy.

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