الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cancer is a disease of ageing; approximately 60% of all cancers and 70% of cancer mortality occur in persons aged 65 years and older
CGA has been suggested as a useful geriatric oncology tool for separating patients likely to benefit from standard cancer treatment and patients who are at high risk for complications and/or are too vulnerable to receive aggressive therapy.
A CGA comprises the following domains: functional status, comorbidity, polypharmacy, cognition, psychological status, social support, and nutritional status
Cancer of the prostate (PCa) is currently the second most common cause of cancer death in men. In developed countries, PCa accounts for 15% of male cancers compared with 4% of male cancers in developing countries
Data from Egypt national cancer registry Aswan 2008 reported that prostatic cancer is the 5th most common cancer in men representing about 5.9% of all male cancer and representing 2.7% of all cancer cases
At present, only three risk factors for prostate cancer have been firmly established; these are all non-modifiable: age, race, and a positive family history of prostate cancer. However, numerous modifiable factors have also been implicated in the development of prostate cancer e.g. diet, hypertension, obesity, smoking and history of prostatitis or sexually transmitted disease.
Serum PSA, DRE and trans rectal ultrasonography constitute the three major diagnostic means for the detection of this cancer. A combination of information about the extent of the primary tumor (T), lymph node (N) involvement, and presence or absence of distant metastases (M) with the Gleason score of the primary tumor and the serum PSA level are used to classify men according to their risk of recurrence.
Our primary research question was to compare treatment effects on HR-QOL, and underlining the utility of CGA prior to initiation of treatment with curative intent.
This study was conducted on one group of 70 older adults aged 65 years old and above who diagnosed with localized prostate cancer. We studied the sociodemographic data and tumor characteristics of the studied population, then we prospectively administered a battery of geriatric screening tests (MNA, GDS, timed up and Go Test, CIRSG, ADL, IADL, MMSE), ) and self-rated health was measured using the short form 36 health survey (SF36) and Expanded prostate cancer composite for clinical practice (EPIC).
CGA
Upon assessment 34.3% of the patients were at risk of depression according to the results of the geriatric depression scale, while 2.9% had definite depression , assessment 2 months following treatment showed significant increase in the risk of depression
The ADL and IADL were impaired in 60% and 40% of the patients respectively before treatment .A significant increase in the percentage of ADL impairment was detected up to 71.4% of the patients. While there was no significant difference as regarding IADL.
40% of the patients presented with mild cognitive disorders upon initial assessment but no sever cognitive impairment was detected. There was no significant difference from the baseline upon follow up assessment in our study.
20% of the patients were considered to be at risk of falls according to TUGT. There was no significant increase in the risk of falls in this study group.
In addition to contributing to decisions about cancer treatment, the CGA is valuable for developing care programs tailored to individual patients. Such programs may include interventions to correct identified geriatric factors and reversible comorbidities.
EPIC
For those who received EBRT (external beam radiation therapy) worsening in base line, bowel function and hormonal domain were noted among the treatment group (p<0.001).
While for those who did radical prostatectomy worsening in base line incontinence and sexual function were noted among the treatment group (p<0.001). While irritation/obstruction symptoms showed improvement following surgery.
SF-36
Of the eight SF-36 domains, radical prostatectomy group had significant worsening from the base line score on physical function, emotional well-being, energy and fatigue and bodily pain. However other domains including social functioning and general health showed no
significant differences.
On the other hand, the patients in the radiotherapy group showed significant worsening base line score on physical function, limitations due physical problems, energy and fatigue and emotional wellbeing. However other domains including, limitations due to emotional, social functioning bodily pain and general health showed no significant differences.
In this study we have evaluated short-term HRQoL outcomes following different CaP treatments; however, because of the protracted nature of recovery after surgery, delayed onset of effects from radiation, potential interval decline caused by age-related symptoms, and longevity of patients with CaP, more information must be gathered about long-term outcomes. Such data will aid in effective counseling and patient satisfaction with treatment choice as expectations will be more concordant with HRQoL results. Furthermore, increase in physician awareness concerning the impact of treatment on HRQoL change over time may further refine techniques and render more effective follow-up care.