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Article

Prostate Cancer Diagnosis and Treatment in Elderly Patients: A Cross-Sectional Survey Exploring Practice Patterns and Preferences of Uro-Oncologists in Northeast Italy

by
Filippo Carletti
1,
Giuseppe Reitano
1,
Laura Evangelista
2,
Filippo Alongi
3,4,
Alessandro Antonelli
5,
Umberto Basso
6,
Roberto Bortolus
7,
Matteo Brunelli
8,
Orazio Caffo
9,
Fabrizio Dal Moro
1,
Rocco De Vivo
10,
Mario Gardi
1,
Rossano Girometti
11,12,
Andrea Guttilla
13,
Fabio Matrone
7,
Matteo Salgarello
14,
Marco Andrea Signor
15,
Fabio Zattoni
1,*,†,
Gianluca Giannarini
16,† and
on behalf of Gruppo Uro-Oncologico del Nord Est (GUONE)
1
Urology Clinic, Department of Surgery Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
2
Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
3
Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Negrar, 37024 Verona, Italy
4
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Università di Brescia, 25121 Brescia, Italy
5
Urology Unit, University of Verona, 37129 Verona, Italy
6
Oncology Unit, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padua, Italy
7
Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
8
Pathology Unit, University of Verona, 37129 Verona, Italy
9
Oncology Unit, Santa Chiara Hospital, 38122 Trento, Italy
10
Department of Oncology, Ospedale san Bartolo, 36100 Vicenza, Italy
11
Department of Medicine, University of Udine, 33100 Udine, Italy
12
University Hospital S. Maria della Misericordia, ASUFC, 33100 Udine, Italy
13
Urology Unit, ULSS 6 Euganea, 35012 Camposampiero, Italy
14
Nuclear Medicine Unit, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy
15
Radiation Therapy Unit, SMM University Hospital Udine, 33100 Udine, Italy
16
Urology Unit, SMM University Hospital Udine, 33100 Udine, Italy
 
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*
Author to whom correspondence should be addressed.
†
These authors contributed equally as senior authors.
Diagnostics 2025, 15(9), 1100; https://doi.org/10.3390/diagnostics15091100
Submission received: 30 December 2024 / Revised: 29 March 2025 / Accepted: 24 April 2025 / Published: 25 April 2025
(This article belongs to the Special Issue Recent Advances in Prostate Cancer Imaging and Biopsy Techniques)
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Abstract

Background: The optimal diagnostic and therapeutic strategies for prostate cancer (PCa) in patients aged ≥75 years (mild-old and oldest-old) are still contentious. Resource allocation and ideal treatment for older patients are challenges, mainly due to their comorbidities and reduced life expectancy. This survey aims to assess current clinical practices and the experiences of healthcare providers in the diagnosis and management of elderly patients with PCa. Materials and Methods: In Northeast Italy, members of the Gruppo Uro-Oncologico del Nord-Est (GUONE) conducted a survey involving 104 physicians of different specialties (Nuclear Medicine, Medical Oncology, Radiation Oncology, Radiology, Urology) between 1 November 2024 and 30 November 2024. The survey encompassed 51 questions, evaluating various diagnostic and therapeutic scenarios. Results: Digital rectal exam (DRE) was recommended by 35.9% of physicians for patients aged 75 or older at risk of PCa. PSA testing was continued in 76.3% of these patients. For 36.5% of the physicians, there should be no age limit for prostate biopsy. Moreover, 42.6% of physicians recommended a magnetic resonance imaging (MRI)-guided prostate biopsy regardless of age. A prostate biopsy was deemed mandatory before initiating any form of hormonal therapy by 57.7% of the participants. For 22.3% and 34.7% of physicians, there should be no age limit for prostate MRI and PET/CT for staging purposes. Interestingly, PET/CT was not recommended in 52% of cases as a staging tool for patients older than 85 years. For patients without comorbidities, the age limit to consider radical prostatectomy (RP) was 75, with 58.6% of physicians in favor. There were no definitive limits for radiotherapy (RT). Chemotherapy had an age limit for 81.6% of the respondents; for 18.4%, 22.5%, and 26.5% of physicians, age limits were 75, 80, and 85 years, respectively. The use of androgen receptor pathway inhibitors (ARPIs) had no definitive age limits for 46.5% of respondents. For patients with no comorbidities and low-volume metastatic PCa, the preferred option was androgen deprivation therapy + ARPIs + RT. The follow-up schedule after RP or RT exhibited heterogeneity with no consensus regarding the frequency of PSA testing or the age at which it should be discontinued. Conclusions: This survey highlights the need for consensus guidelines in diagnosing and managing mild-old and oldest-old elderly PCa patients. With the aging population, standardized protocols are essential to ensure optimal care.
Keywords: elderly; PCa; prostate cancer; survey; old; aging population elderly; PCa; prostate cancer; survey; old; aging population

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MDPI and ACS Style

Carletti, F.; Reitano, G.; Evangelista, L.; Alongi, F.; Antonelli, A.; Basso, U.; Bortolus, R.; Brunelli, M.; Caffo, O.; Dal Moro, F.; et al. Prostate Cancer Diagnosis and Treatment in Elderly Patients: A Cross-Sectional Survey Exploring Practice Patterns and Preferences of Uro-Oncologists in Northeast Italy. Diagnostics 2025, 15, 1100. https://doi.org/10.3390/diagnostics15091100

AMA Style

Carletti F, Reitano G, Evangelista L, Alongi F, Antonelli A, Basso U, Bortolus R, Brunelli M, Caffo O, Dal Moro F, et al. Prostate Cancer Diagnosis and Treatment in Elderly Patients: A Cross-Sectional Survey Exploring Practice Patterns and Preferences of Uro-Oncologists in Northeast Italy. Diagnostics. 2025; 15(9):1100. https://doi.org/10.3390/diagnostics15091100

Chicago/Turabian Style

Carletti, Filippo, Giuseppe Reitano, Laura Evangelista, Filippo Alongi, Alessandro Antonelli, Umberto Basso, Roberto Bortolus, Matteo Brunelli, Orazio Caffo, Fabrizio Dal Moro, and et al. 2025. "Prostate Cancer Diagnosis and Treatment in Elderly Patients: A Cross-Sectional Survey Exploring Practice Patterns and Preferences of Uro-Oncologists in Northeast Italy" Diagnostics 15, no. 9: 1100. https://doi.org/10.3390/diagnostics15091100

APA Style

Carletti, F., Reitano, G., Evangelista, L., Alongi, F., Antonelli, A., Basso, U., Bortolus, R., Brunelli, M., Caffo, O., Dal Moro, F., De Vivo, R., Gardi, M., Girometti, R., Guttilla, A., Matrone, F., Salgarello, M., Signor, M. A., Zattoni, F., Giannarini, G., & on behalf of Gruppo Uro-Oncologico del Nord Est (GUONE). (2025). Prostate Cancer Diagnosis and Treatment in Elderly Patients: A Cross-Sectional Survey Exploring Practice Patterns and Preferences of Uro-Oncologists in Northeast Italy. Diagnostics, 15(9), 1100. https://doi.org/10.3390/diagnostics15091100

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