SciELO - Scientific Electronic Library Online

 
vol.20 issue5-6Dysphonia in teachers of the first grade of educationPhenylketonuria revisited author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

  • Have no similar articlesSimilars in SciELO

Share


Arquivos de Medicina

On-line version ISSN 2183-2447

Arq Med vol.20 no.5-6 Porto Sept. 2006

 

Carcinoma da Próstata e Envelhecimento

Aspectos Preocupantes

 

Francisco Madeira Pina*, Nuno Lunet†, Manuel Macedo Dias‡

*Serviço de Urologia, Hospital de São João, Porto; † Serviço de Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto; ‡Serviço de Anatomia Patológica, Hospital de São João, Porto

 

Resumo

O envelhecimento cursa com adaptações de hormonas, citocinas, e factores de crescimento progressivas, umas com função provavelmente protectora, outras ligadas ao aumento de risco de morte por causas cardiovasculares e neoplásicas. Relativamente às terapêuticas androgénicas de substituição no idoso, em utilização crescente e prolongada, mantem se a dúvida sobre o impacto no risco de desenvolvimento do cancro da próstata. A nossa experiência em casos incidentes de cancro da próstata demonstra que, à medida que a idade avança, sobe também a proporção de doentes com cancros da próstata com piores factores de prognóstico de recidiva/progressão (PSA basal mais elevado, risco de metastização óssea, tumores com pior diferenciação histológica). Enquanto que a prevenção primária quimio-endócrina aguarda resultados de vários estudos em curso (nomeadamente com inibidores da 5 α-reductase, selénio e vitamina E) para se afirmar, a prevenção secundária, baseada em resultados parciais de grandes estudos internacionais e na expansão das medidas básicas do diagnóstico precoce (exame digital rectal e PSA), avança com a generalização das terapêuticas radicais. A nossa experiência de 15 anos de prostatectomia radical revela que os indivíduos idosos (> 65 anos) representam metade dos candidatos, nos quais se observa uma maior proporção de indivíduos com tumores com Gleason ≥ 7, e maior proporção de indivíduos classificados em grupos de maior risco de recidiva/progressão. As diferentes formas de hormonoterapia, integradas na prevenção terciária, como adjuvante de terapêuticas radicais, como paleação de doentes em recidiva bioquímica, ou no contexto de tratamento primário paliativo, apresentam vantagens e desvantagens que devem ser individualmente ponderadas.

Palavras-chave: cancro da próstata; epidemiologia; envelhecimento; prevenção; terapêutica androgénica de substituição; hormonoterapia.

 

 

Prostate Cancer and Aging

Abstract

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.

Key-words: prostate cancer; epidemiology; aging; prevention; androgen replacement therapy; hormonotherapy.

 

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

 

REFERÊNCIAS

1 -Lunenfeld B. The ageing male: demographics and challenges. World J Urol 2002;20:11-6.         [ Links ]

2 -Swerdloff RS, Wang C, Hines M, Gorski R. Effect of androgens on the brain and other organs during development and aging. Psychoneuroendocrinology 1992; 17:375-83.

3 -Lund BC, Bever-Stille KA, Perry PJ. Testosterone and andropause: the feasibility of testosterone replacement therapy in elderly men. Pharmacotherapy 1999;19:951-6.

4 -Basaria S, Dobs AS. Risks versus benefits of testosterone therapy in elderly men. Drugs Aging, 1999;15:131-42.

5 -Juul A, Skakkebaek NE. Androgens and the ageing male. Hum Reprod Update 2002;8:423-33.

6 -Swerdloff RS, Wang C. Androgens and the ageing male. Best Pract Res Clin Endocrinol Metab 2004;18:349-62.

7 -Untergasser G, Rumpold H, Hermann M, Dirnhofer S, Jilg G, Berger P. Proliferative disorders of the aging human prostate: involvement of protein hormones and their receptors. Exp Gerontol 1999;34:275-87.

8 -Heaton JP. Andropause: coming of age for an old concept? Curr Opin Urol 2001;11:597-601.

9 -Heaton JP. Point: urologists should take an active role in the diagnosis and treatment of hypogonadism in the aging ma-le. Can J Urol 2002;9:1677-80.

10 -Casey RW. Counterpoint: urologists should take an active role in the diagnosis and treatment of hypogonadism in the aging male. Can J Urol 2002;9:1681-3.

11 -Tan RS, Culberson JW. An integrative review on current evidence of testosterone replacement therapy for the andro-pause. Maturitas, 2003;45(1):15-27.

12 -Schulman C, Morales A, Baulieu E, et al. Assessing the risk of androgen supplementation, in Prostate Cancer. Edition 2003; 3rd International Consultation on Prostate Cancer - Paris (UICC; WHO, IARC, SIU) Committee 9:323-31

13 -Hijazi RA, Cunningham GR. Andropause: is androgen replacement therapy indicated for the aging male? Annu Rev Med 2005;56:117-37.

14 -Ebert T, Jockenhovel F, Morales A, Shabsigh R. The current status of therapy for symptomatic late-onset hypogonadism with transdermal testosterone gel. Eur Urol 2005; 47:137-46.

15 -Schulman C, Lunenfeld B. The ageing male. World J Urol 2002;20:4-10.

16 -Perry PJ, Yates WR, Williams RD, et al. Testosterone therapy in late-life major depression in males. J Clin Psychiatry 2002; 63:1096-101.

17 -Potosky AL, Miller BA, Albertsen PC, et al. The role of increasing detection in the rising incidence of the prostate cancer (National Cancer Institute Surveillance; American Medical Association). JAMA 1995;273:548-52.

18 -Boyle P, Severi G, Giles GG. The epidemiology of prostate cancer. Urol Clin N Am 2003;30:209-17.

19 -Schroder FH, Gosselaar C, Roemeling S, et al. Detection of prostate cancer after 2005. Part I, EAU-EBU update serie in 2006;4(1):2-12.

20 -Schroder FH, Gosselaar C, Roemeling S, et al. PSA and the detection of prostate cancer after 2005. Part II: mays out of the PSA dilemma. EAU-EBU update serie in 2006;4(2):71-81.

21 -Otto SJ, Konong HJ. Screening for prostate cancer - is mor-tality reduction already proven?, in Renal, bladder, prostate and testicular cancer: an update. Progress and Controversies in Oncological Urology (PACIOU VI). Edition 2001; Section IV Cap.16:159-66.

22 -Wolff JM, Borchers H, Rohde D, Jakse G. Age related chan-ges of free and total prostate specific antigen in serum. Anticancer Res 1999;19(4A):2629-32.

23 -Berger AP, Cheli C, Levine R, Klocker H, Bartsch G, Hornin-ger W. Impact of age on complexed PSA levels in men with total PSA levels of up to 20 ng/mL. Urology 2003; 62:840-4.

24 -Richardson TD, Oesterling JE. Age-specific reference ran-ges for serum prostate-specific antigen. Urol Clin North Am 1997;24:339-51.

25 -Kirollos MM. Statistical review and analysis of the relationship between serum prostate specific antigen and age. J Urol 1997;158:143-5.

26 -Slovacek KJ, Riggs MW, Spiekerman AM, Speights VO Jr. Use of age-specific normal ranges for serum prostate-specific antigen. Arch Pathol Lab Med 1998;122:330-2.

27 -Heimdal K, Fossa SD. Urologic cancer in elderly patients. Curr Opin Oncol 1993;5:568-73.

28 -Hall WH, Jani AB, Ryu JK, Narayan S, Vijayakumar S. The impact of age and comorbidity on survival outcomes and treatment patterns in prostate cancer. Prostate Cancer Prostatic Dis 2005;8:22-30.

29 -Gilbert SM, McKiernan JM. Epidemiology of male osteoporosis and prostate cancer. Curr Opin Urol 2005; 15:23-7.

30 -Wei JT, Gross M, Jaffe CA, et al. Androgen deprivation therapy for prostate cancer results in significant loss of bone density. Urology 1999;54:607-11.

31 -Higano CS. Side effects of androgen deprivation therapy: monitoring and minimizing toxicity. Urology 2003;61(2 suppl 1):32-8.

32 -Wirth M, Tyrrel C, Wallace M, et al. Bicalutamide (Casodex) 150 mg as immediate therapy in patients with localized os locally advanced prostate cancer significantly reduces the risk of disease progression. Urology 2001;58:146-51.

33 -See WA, Wirth MP, McLeod DG, Iversen P, et al. Bicalutamide as immediate therapy either alone or as adjuvant to standard care of patients with localized or locally advanced prostate cancer: first analysis of the early prostate cancer program. Journal of Urology 2002;168:429-35.

34 -Schellhammer PF. An evaluation of bicalutamide in the treatment of prostate cancer. Expert Opin Pharmacother 2002;3:1313-28.

 

Correspondência:

Dr. Francisco Madeira Pina

Serviço de Urologia

Hospital de São João

Alameda Prof. Hernâni Monteiro

4200 - 319 Porto

e-mail: madeirapina@gmail.com

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License