Re: Geriatric 8 screening of frailty in patients with prostate cancer

Abstract

Prostate cancer is the most common disease in elderly Japanese men.1, 2 A geriatric assessment is therefore required for prostate cancer patients. Momota et al. showed the usefulness of the Geriatric 8 (G8) assessment tool as a prognostic factor for advanced prostate cancer patients, with a lower G8 score indicating a worse prognosis in both metastatic hormone-naïve prostate cancer and castration-resistant prostate cancer (CRPC) patients.3 They also showed that the G8 score was higher for patients treated by robot-assisted radical prostatectomy than for those treated with radiotherapy and androgen deprivation therapy alone. The G8 is an eight-item screening tool consisting of seven factors taken from the Mini Nutritional Assessment and the patient’s age that was developed for use in older cancer patients.4 This tool covers multiple domains usually assessed by geriatricians and takes <5 min to carry out. The total score ranges from 0 to 17, and the cut-off points vary among studies. At our institution, we assessed the G8 score for 76 localized prostate cancer patients, and the mean score was 15.2 for patients who underwent radical prostatectomy, 14.1 for those who underwent radiotherapy and 13.6 for those who underwent androgen deprivation therapy. In that study, the mean G8 score for localized prostate cancer was 14.5, the G8 score for those who underwent robot-assisted radical prostatectomy was 15.0, radiotherapy was 14.0 and androgen deprivation therapy was 12.0. These trends were also consistent with our cohort.3 We speculated that the differences of G8 score for each treatment strategy came from the invasiveness which clinician evaluated for each treatment. We also examined the G8 score of 68 CRPC patients from April to August 2018. We evaluated the G8 score in terms of the CRPC treatment. We assessed the pre-medicated G8 screening score for patients with treatment or medication. Compared with enzalutamide (ENZ) or radium-223 (Ra-223), abiraterone acetate (ABI) and systemic chemotherapy, such as docetaxel (DOC) and/or cabazitaxel (CBZ), showed a high G8 screening score (ENZ 12.1 ± 1.9, ABI 13.4 ± 1.8, DOC 13.8 ± 2.0, CBZ 13.6 ± 2.6, Ra-223 11.8 ± 1.7; Fig. S1). The G8 score for ENZ was shown to be significantly lower than ABI and DOC (P = 0.044 and P = 0.021, respectively), but not CBZ (P = 0.215). The G8 score for Ra-223 was also lower than ABI and DOC (P = −0.030 and P = 0.015, respectively), but not significantly CBZ (P = 0.148). At our institution, 12 urologists decide which treatment to carry out for CRPC patients at each urologist’s decision. Based on these results, clinicians choose systemic chemotherapy treatment for patients with a high G8 screening score, this means that clinicians consider ABI and systemic chemotherapy to be relatively invasive treatment. In contrast, the ENZ and Ra-223 groups showed relatively low G8 screening scores. At our institution, there were no differences in the mean age of patients receiving ABI and ENZ (75.8 years and 74.9 years, respectively), and the G8 screening score differed between these two groups. When considering second-generation anti-androgen agents, clinicians might prefer ENZ over ABI, because ENZ does not necessitate the use of steroids, especially for elderly CRPC patients treatment. Clinicians also recognized that Ra-223 treatment was well tolerated by elderly patients, even those with a low G8 screening score. Given the present findings, the G8 score for each CPRC treatment might reflect the level of invasiveness, which urologists evaluate for each treatment. None declared. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.