February 1, 2015

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

    Volume III, Winter 2007


Frailty and Surviving Prostate Cancer

Age matters in prostate cancer. The vast majority of men diagnosed with prostate cancer, and nearly all of the men who die from it, are over age 65. And yet, despite the recent compelling evidence that surgical intervention for prostate cancer can save lives, "many physicians do not routinely screen their older patients for prostate cancer," notes gerontologist Sheila Gonzalgo, M.D, M.P.H., the Carolyn and Bill Stutt Scholar. Even when they do, many of these men "may not receive potentially curative treatment," because their doctors think they're too old for it.

But general health matters, too, and not all men in their late sixties and over are alike. Some are hearty and vigorous, and some are plagued by health problems and frailty. This makes a huge difference in how men recover from illness, Gonzalgo adds, and it's going to become increasingly important as the Baby Boomer generation ages. There is a "demographic imperative," Gonzalgo believes, to determine which older men would benefit the most from prostate cancer screening and surgical intervention — and which would benefit the least.

Some men in their late sixties
are vigorous, and some are
plagued by health problems.
This makes a huge difference in
how men recover from illness.

"For example, we might expect an active 65-year-old man with no other illnesses to recover fully from the common cold," she explains. But that same cold might be much rougher on a man of the same age who is diabetic, who smokes, has heart disease, and doesn't exercise. "Gerontologists are in the process of defining what it means to age exceptionally. At the other end of the spectrum are the most vulnerable older adults, people afflicted with frailty — a biological syndrome characterized by muscle weakness, lack of stamina, and weight loss."

Using information collected from the Cardiovascular Health Study, Gonzalgo is working to see how a man's general health — his likelihood of disability and death from other causes — affects his chances of being helped by surgery.



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