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Dying with dignity: Role of palliative care services in improving outcomes for terminally ill geriatric veterans
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Introduction: Malnutrition is a serious concern occurring in patients with cancer. Cancer is frequent in elderly patients and malnutrition is consequently even more frequent. The aim of this study was to evaluate the impact of home parenteral nutrition on Quality-of-life (QOL) in elderly malnourished patients suffering from cancer. Materials and methods: This French prospective observational study included patients, aged 70 years or older, with cancer, for whom home parenteral nutrition (HPN) was prescribed for at least 14 days. The main objective was to evaluate the evolution of the QOL. A representative sample of 176 centers specialized in oncology were randomly constituted from an exhaustive national database. The patient, the physician and a family member had to fill in a questionnaire at inclusion and 28 days later. Results: Between September 2009 and March 2010, 221 patients aged 70 years or older were included in the study. The patients were suffering mainly from a digestive, oropharyngeal or respiratory system cancer. At inclusion, 79.8% of patients had an altered performance status. The HPN was appropriately accomplished in 70% of patients. After 28 days of HPN intake, improved weight was noticed in 68% and 14% of patients had reached the target weight. Significant improvements were reported in serum albumin level and NRI. PS score improved in 21% of patients. Major adverse events were nausea (17%), vomiting (11%), diarrhea (12%), chills (11%) and hyperthermia (11%). Improved global QOL was reported in 59% of patients. After 28 days, global QOL was significantly improved. Significant differences were observed for the physical, emotional and functional compounds, but not for the social/familial compound of the QOL. A positive impact of the HPN was perceived in 76% of patients, and the autonomy was not affected with the introduction of HPN in 47% of cases. Physicians noticed a significant improvement in the physical, emotional and functional status. Family members, friends or home caregivers noticed a significant improvement only in the emotional status. Conclusion: These results showed a significant benefit of the HPN on the QOL in elderly patients with cancer. The routine management of these patients must include HPN.
doi:10.1016/j.jgo.2012.10.099
P99 Dying with dignity: Role of palliative care services in improving outcomes for terminally ill geriatric veterans N. Sharma⁎, A.M. Sharma, A. Gajra. Department of Medicine, S.U.N.Y. Upstate Medical University, Syracuse, NY 13210, USA Purpose of the Study: Cancer and cardiovascular disease are the leading causes of death in elderly1. Every year, millions of dollars are spent in treatment of advanced cancer, often resulting in financial and emotional losses to the patients and their caregivers2. Studies have shown that palliative care services (PCS) can be tailored to reduce costs and improve quality of life3–4. Aim: The aim is to study the impact of early initiation of palliative care services (PCS) at our institution for geriatric patients with advanced cancer. Sub-aims a) To compare the utilization of palliative care services between young (b65 years) and older (N65 years) veterans. b) To analyze outcomes of early PCS initiation between the two groups. c) To study the role played by social factors (living condition, marital status) in acceptance of PCS. Methods: Retrospective chart review veterans who utilized PCS between 2002 and 2009. We compared 195 young (40–64 years old,
young group) with 372 (N64 years, old group) veterans. Outcomes of interest, i.e. day of referral to hospice before death (DRHBD), mean length of stay in hospice before death (NDHBD), utilization of hospital resources in the last month of life, i.e. ER visits (ERVLM), hospital admissions in last month of life (HALM) and ICU admissions in last month of life (ICULM) were compared using independent sample t-test. Multi-variate regression was performed to compare the role played by social factors in achieving the desired outcomes. Results: Out of the 567 veterans who met the eligibility criteria (age 40–100, death, acceptance of PCS), almost 96% were Caucasian males (Table 1). Lung cancer accounted for the majority of patients (47% in young vs. 48% in older group); followed by gastro-intestinal, head and neck and genitourinary cancers. Early referral to PCS was seen in the old group [DRHBPD: 47.31st day versus 34.50th day]. Older veterans spent more time in hospice [NDHBPD: 30.96 versus 20.24] than the younger group resulting in significantly lesser ER visits [ERVLM: 0.69 versus 0.80, p = 0.05], hospital admissions [HALM: 0.72 versus 0.86, p b 0.05], and ICU admissions [ICULM: 0.14 versus 0.22, p b 0.05] in the last month of life (Table 2). We conducted multi-variate logistic regression analysis that adjusted for location of cancer and social support, including marital status and living conditions. These factors were not statistically significantly associated with the outcomes variables and did not confound the association between age and outcome variables. However, in spite of adequate management by PCS, greater than 50% of veterans in both groups had higher utilization of ER visits and hospital admissions (Table 3). Caregiver fatigue and fear of watching a loved one passing away, lack of administrative support were the common factors that were cited for increased utilization of hospital resources. Conclusions: We used surrogate markers to highlight better outcomes in last month of life for older patients with advanced cancer. Not only early initiation of palliative care services is cost-effective, it improves the quality of life and results in better satisfaction among care-givers. This model of PCS at VAMC can be expanded further to set up satellite clinics exclusively tailored to provide medical and emotional care at the bedside thereby, reducing unnecessary health care utilization. References 1. Sahyoun NR, Lentzner H, Hoyert D, Robinson KN. Trends in Causes of Death Among the Elderly. Aging Trends; No.1.Hyattsville, Maryland: National Center for Health Statistics. 2001. 2. Retrieved from http://www.usatoday.com/news/health/2008-1012-cancer-costs_n.htm. 3. Keating NL; Landrum, MB; Lamont EB; Earle CC; Bozeman S and Mcneil BJ. End-of-Life Care for Older Cancer Patients in the Veterans Health Administration Versus the Private Sector. Journal…. 4. Gonsalves, WI et al. Effect of palliative care services on the aggressiveness of end-of-life care in the Veteran's Affairs cancer population. J Palliat Med. 2011 Nov;14(11): 1231–5. Table 1 Demographics of the sample. Variable Race
Young group (40–64) N = 195
Caucasian 177 (90.7%) African 15 (7.6%) American Hispanic 2 (1.02%) Unknown 1 (0.5%) Sex Male 186 (95.4%) Female 9 (4.6%) Location of Lung and pleura 92 (47.17%) cancer Gastrointestinal1 46 (23.5%) Head and neck 24 (12.3%) Lymph nodes 13 (6.67%) Genito-urinary 8 (4.1%) Others 12 (6.1%)
Old group (65 and above) N = 372 357 (95.9%) 13 (3.49%) 1 (0.2%) 0 367 (98.6%) 5 (1.4%) 182 (48.92%) 85 (22.8%) 38 (10.2%) 17 (4.5%) 38 (10.2%) 12 (3.2%)
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Table 1 (continued) Variable Marital status
Living condition
1 2 3
Young group (40–64) N = 195 Married Divorced Widowed Single Unknown Home with family Home alone Nursing home
Old group (65 and above) N = 372
70 (35.9%) 78 (40%) 9 (4.6%) 33 (17%) 0 104 (53.3%)
173 (46.5%) 86 (23%) 76 (20.4%) 33 (8.9%) 4 (1%) 207 (55.6%)
86 (44.1%) 5 (2.6%)
140 (37.6%) 25 (6.7%)
Includes stomach, esophagus, duodenum, abdomen, liver, pancreas, and colorectal. Includes bladder and prostate. Includes skin, soft tissue, adrenal, breast, ovary, and unknown.
Variable
Young Old Significance group(n = 195) group(n = 372)
Mean day of referral to hospice before patient died(DRHBPD) Mean number of days in hospice before patient died(NDHBPD) Mean number of ER visits in last month of life(ERVLM) Mean number of hospital admissions in the last month of life(HALM) Mean number of ICU admissions in the last month of life(ICULM)
34.50th day
47.31st day
P b 0.01
20.24 days
30.96 days
P b 0.01
0.80
0.69
P = 0.05
0.86
0.72
P = 0.02
0.22
0.14
P b 0.01
Table 3 Utilization of hospital services by two groups.
Death in hospital Death at home Chemotherapy in month ERVLM HALM ICULM
Young (N = 195)
doi:10.1016/j.jgo.2012.10.101
Prostate cancer P101 Prostate cancer in elderly patients
Table 2 Comparison of outcomes between two groups.
Variable
leukemia/myeloma: 8; solid tumors: 44 (lung: 5; gastrointestinal: 10; head neck: 7; gastrointestinal: 10; breast: 12; genitourinary: 10). Patients who completed the planned treatment were 38. Few of the patients, finished CGA (comprehensive geriatric assessment) as validation process. Conclusion: This is our first attempt at segregating geriatric cancer patient population. In the future, treatment outcomes and tolerability of the aggressive management, dose reduction, will be reported.
Old (N = 372)
P-value (twotailed)
31 (15.8%) 164 (84.2%) last 26 (13.3%)
48 (12.9%) 324 (87.1%) 37 (9.9%)
0.37 0.37
116 (60%) 127 (65%) 38 (19.4%)
199 (53.4%) 218 (58.6%) 48 (12.9%)
0.086 0.14 0.048
doi:10.1016/j.jgo.2012.10.100
P100 Geriatric oncology in India: A data on patient profile from one of the cancer centers in North India A. Vora⁎, S. Mukopadhyay, A. Upadhyay, V. Goyal, V. Kabra, G. Kadyapat, A. Roy, R. Singh Anupama Nehra Hooda, A.K. Anand, H. Chaturvedi. Department of Medical, Radiation and Surgical Oncology, Max Healthcare, New Delhi, India Introduction: This is the first attempt to look at the geriatric patients' profile visiting cancer center at our hospital in the last 1 year. Historically, geriatric patients were not included in clinical trials and also majority of the times were put into ‘supportive care only’, bracket. Lately, geriatric oncology is being recognized as a separate subspeciality. Materials and methods: In the last 1 year, all patients above 65 years, diagnosed with cancer and visiting our center, were evaluated. A proforma was filled, and analyzed. The tumor board was discussed with all patients and they were offered treatment depending on current standards and patients' performance status. Results: The total number of patients evaluated was 52. Male:female ratio was 16:36. Agewise distribution: N65 years: 52; N70 years: 22; N75 years: 7; N80 years: 3. Cancer sitewise distribution: lymphoma/
P. Caillet⁎1,2, S. Sebbagh3, J.-L. Lagrange4, M. Laurent1,2, C. Tournigand3, S. Culine5, E. Paillaud1,2 for the ELCAPA Study Group† 1 Department of Internal Medicine and Geriatrics, Geriatric Oncology Clinic, AP-HP, Henri Mondor Hospital, Créteil, France, 2Paris Est Créteil University (UPEC), LIC EA 4393, Créteil, France, 3Department of Medical Oncology, AP-HP, Henri-Mondor Hospital, Créteil, France, 4Department of Radiotherapy, AP-HP, Henri-Mondor Hospital, Créteil, France, 5Department of Medical Oncology, AP-HP, Saint Louis Hospital, Paris, † France, The ELCAPA Study Group was composed of three oncologists (S. Culine, C. Tournigand, and M. Chaubet), one radiotherapist (J.L. Lagrange), five geriatricians (P. Caillet, M. Laurent, E. Liuu, E. Paillaud and H. Vincent), two epidemiologists (F. Canouï-Poitrine and S. BastujiGarin), one pharmacist (M. Carvahlo-Verlinde), one bio-statistician (A. Le Thuaut), one medical doctor of clinical research (N. Reynald) and one assistant of clinical research associate(N. Boudjema). Purpose: To assess the feasibility of proposed anticancer treatments in 70 years and older men with prostate cancer. Patients and method: Retrospective descriptive study including 69 patients 70 years old and over referred in geriatric oncology consultation for an overall assessment in the context of the anticancer treatment plan. Collected data: demographics and comprehensive geriatric assessment data; tumor characteristics; noncompletion and toxicities of the different proposed anticancer treatments. Results: Sixty-nine patients were included (median age: 77 years (70–93 years)). 98.6% were diagnosed with prostate adenocarcinoma (one patient with neuroendocrin contingent). At the time of diagnosis, median PSA was 12.7 ng/ml (1.3–400), median Gleason score was 7 (6–10) and 11 patients (16.4%; 11/67) had metastases. Only 22 patients had an ECOG status of ≥2 (31.9%). The geriatric assessment revealed that 27.5% of the patients lived alone at home (n = 19). 26.1% of cases (n = 18) had one or more dependency for basic activities of daily living (ADL) and 44.9% of cases (n = 31) had fall risk. Nutritional status was impaired in 31.9% of cases (n = 22). Cognitive impairment and depressive syndrome were present respectively in 17.0% (8/47) and 19.4% (12/62) of cases. Hypertension and renal failure were the two main comorbidities respectively found in 58.0% and 44.6% (29/65) of cases. Among patients, 19 (27.5%) had surgical treatment: 13 radical prostatectomy (68.4%) and 6 endoscopic resection (31.6%), with only one complication (anastomotic stenosis after radical prostatectomy). Forty-two patients were treated with radiation therapy. The planned radiation therapy treatment has been fully competed in 92.9% of cases (39/40), with acute toxicity in 26 patients (68.4%; 26/38), mostly grades I and II (95.8%; 23/24). Among the 51 patients with an indication for first-line hormone therapy, 18 patients (36%) received a combination therapy for a median duration of 1 year (0.2–6.3 years). A maximum of four lines of hormone therapy per patient have been proposed and no safety problems have been reported.
J O U RN A L OF GE R IAT RI C O N COL O G Y 3 ( 2 0 12 ) S3 3 –S 10 2
Introduction: Malnutrition is a serious concern occurring in patients with cancer. Cancer is frequent in elderly patients and malnutrition is consequently even more frequent. The aim of this study was to evaluate the impact of home parenteral nutrition on Quality-of-life (QOL) in elderly malnourished patients suffering from cancer. Materials and methods: This French prospective observational study included patients, aged 70 years or older, with cancer, for whom home parenteral nutrition (HPN) was prescribed for at least 14 days. The main objective was to evaluate the evolution of the QOL. A representative sample of 176 centers specialized in oncology were randomly constituted from an exhaustive national database. The patient, the physician and a family member had to fill in a questionnaire at inclusion and 28 days later. Results: Between September 2009 and March 2010, 221 patients aged 70 years or older were included in the study. The patients were suffering mainly from a digestive, oropharyngeal or respiratory system cancer. At inclusion, 79.8% of patients had an altered performance status. The HPN was appropriately accomplished in 70% of patients. After 28 days of HPN intake, improved weight was noticed in 68% and 14% of patients had reached the target weight. Significant improvements were reported in serum albumin level and NRI. PS score improved in 21% of patients. Major adverse events were nausea (17%), vomiting (11%), diarrhea (12%), chills (11%) and hyperthermia (11%). Improved global QOL was reported in 59% of patients. After 28 days, global QOL was significantly improved. Significant differences were observed for the physical, emotional and functional compounds, but not for the social/familial compound of the QOL. A positive impact of the HPN was perceived in 76% of patients, and the autonomy was not affected with the introduction of HPN in 47% of cases. Physicians noticed a significant improvement in the physical, emotional and functional status. Family members, friends or home caregivers noticed a significant improvement only in the emotional status. Conclusion: These results showed a significant benefit of the HPN on the QOL in elderly patients with cancer. The routine management of these patients must include HPN.
doi:10.1016/j.jgo.2012.10.099
P99 Dying with dignity: Role of palliative care services in improving outcomes for terminally ill geriatric veterans N. Sharma⁎, A.M. Sharma, A. Gajra. Department of Medicine, S.U.N.Y. Upstate Medical University, Syracuse, NY 13210, USA Purpose of the Study: Cancer and cardiovascular disease are the leading causes of death in elderly1. Every year, millions of dollars are spent in treatment of advanced cancer, often resulting in financial and emotional losses to the patients and their caregivers2. Studies have shown that palliative care services (PCS) can be tailored to reduce costs and improve quality of life3–4. Aim: The aim is to study the impact of early initiation of palliative care services (PCS) at our institution for geriatric patients with advanced cancer. Sub-aims a) To compare the utilization of palliative care services between young (b65 years) and older (N65 years) veterans. b) To analyze outcomes of early PCS initiation between the two groups. c) To study the role played by social factors (living condition, marital status) in acceptance of PCS. Methods: Retrospective chart review veterans who utilized PCS between 2002 and 2009. We compared 195 young (40–64 years old,
young group) with 372 (N64 years, old group) veterans. Outcomes of interest, i.e. day of referral to hospice before death (DRHBD), mean length of stay in hospice before death (NDHBD), utilization of hospital resources in the last month of life, i.e. ER visits (ERVLM), hospital admissions in last month of life (HALM) and ICU admissions in last month of life (ICULM) were compared using independent sample t-test. Multi-variate regression was performed to compare the role played by social factors in achieving the desired outcomes. Results: Out of the 567 veterans who met the eligibility criteria (age 40–100, death, acceptance of PCS), almost 96% were Caucasian males (Table 1). Lung cancer accounted for the majority of patients (47% in young vs. 48% in older group); followed by gastro-intestinal, head and neck and genitourinary cancers. Early referral to PCS was seen in the old group [DRHBPD: 47.31st day versus 34.50th day]. Older veterans spent more time in hospice [NDHBPD: 30.96 versus 20.24] than the younger group resulting in significantly lesser ER visits [ERVLM: 0.69 versus 0.80, p = 0.05], hospital admissions [HALM: 0.72 versus 0.86, p b 0.05], and ICU admissions [ICULM: 0.14 versus 0.22, p b 0.05] in the last month of life (Table 2). We conducted multi-variate logistic regression analysis that adjusted for location of cancer and social support, including marital status and living conditions. These factors were not statistically significantly associated with the outcomes variables and did not confound the association between age and outcome variables. However, in spite of adequate management by PCS, greater than 50% of veterans in both groups had higher utilization of ER visits and hospital admissions (Table 3). Caregiver fatigue and fear of watching a loved one passing away, lack of administrative support were the common factors that were cited for increased utilization of hospital resources. Conclusions: We used surrogate markers to highlight better outcomes in last month of life for older patients with advanced cancer. Not only early initiation of palliative care services is cost-effective, it improves the quality of life and results in better satisfaction among care-givers. This model of PCS at VAMC can be expanded further to set up satellite clinics exclusively tailored to provide medical and emotional care at the bedside thereby, reducing unnecessary health care utilization. References 1. Sahyoun NR, Lentzner H, Hoyert D, Robinson KN. Trends in Causes of Death Among the Elderly. Aging Trends; No.1.Hyattsville, Maryland: National Center for Health Statistics. 2001. 2. Retrieved from http://www.usatoday.com/news/health/2008-1012-cancer-costs_n.htm. 3. Keating NL; Landrum, MB; Lamont EB; Earle CC; Bozeman S and Mcneil BJ. End-of-Life Care for Older Cancer Patients in the Veterans Health Administration Versus the Private Sector. Journal…. 4. Gonsalves, WI et al. Effect of palliative care services on the aggressiveness of end-of-life care in the Veteran's Affairs cancer population. J Palliat Med. 2011 Nov;14(11): 1231–5. Table 1 Demographics of the sample. Variable Race
Young group (40–64) N = 195
Caucasian 177 (90.7%) African 15 (7.6%) American Hispanic 2 (1.02%) Unknown 1 (0.5%) Sex Male 186 (95.4%) Female 9 (4.6%) Location of Lung and pleura 92 (47.17%) cancer Gastrointestinal1 46 (23.5%) Head and neck 24 (12.3%) Lymph nodes 13 (6.67%) Genito-urinary 8 (4.1%) Others 12 (6.1%)
Old group (65 and above) N = 372 357 (95.9%) 13 (3.49%) 1 (0.2%) 0 367 (98.6%) 5 (1.4%) 182 (48.92%) 85 (22.8%) 38 (10.2%) 17 (4.5%) 38 (10.2%) 12 (3.2%)
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Table 1 (continued) Variable Marital status
Living condition
1 2 3
Young group (40–64) N = 195 Married Divorced Widowed Single Unknown Home with family Home alone Nursing home
Old group (65 and above) N = 372
70 (35.9%) 78 (40%) 9 (4.6%) 33 (17%) 0 104 (53.3%)
173 (46.5%) 86 (23%) 76 (20.4%) 33 (8.9%) 4 (1%) 207 (55.6%)
86 (44.1%) 5 (2.6%)
140 (37.6%) 25 (6.7%)
Includes stomach, esophagus, duodenum, abdomen, liver, pancreas, and colorectal. Includes bladder and prostate. Includes skin, soft tissue, adrenal, breast, ovary, and unknown.
Variable
Young Old Significance group(n = 195) group(n = 372)
Mean day of referral to hospice before patient died(DRHBPD) Mean number of days in hospice before patient died(NDHBPD) Mean number of ER visits in last month of life(ERVLM) Mean number of hospital admissions in the last month of life(HALM) Mean number of ICU admissions in the last month of life(ICULM)
34.50th day
47.31st day
P b 0.01
20.24 days
30.96 days
P b 0.01
0.80
0.69
P = 0.05
0.86
0.72
P = 0.02
0.22
0.14
P b 0.01
Table 3 Utilization of hospital services by two groups.
Death in hospital Death at home Chemotherapy in month ERVLM HALM ICULM
Young (N = 195)
doi:10.1016/j.jgo.2012.10.101
Prostate cancer P101 Prostate cancer in elderly patients
Table 2 Comparison of outcomes between two groups.
Variable
leukemia/myeloma: 8; solid tumors: 44 (lung: 5; gastrointestinal: 10; head neck: 7; gastrointestinal: 10; breast: 12; genitourinary: 10). Patients who completed the planned treatment were 38. Few of the patients, finished CGA (comprehensive geriatric assessment) as validation process. Conclusion: This is our first attempt at segregating geriatric cancer patient population. In the future, treatment outcomes and tolerability of the aggressive management, dose reduction, will be reported.
Old (N = 372)
P-value (twotailed)
31 (15.8%) 164 (84.2%) last 26 (13.3%)
48 (12.9%) 324 (87.1%) 37 (9.9%)
0.37 0.37
116 (60%) 127 (65%) 38 (19.4%)
199 (53.4%) 218 (58.6%) 48 (12.9%)
0.086 0.14 0.048
doi:10.1016/j.jgo.2012.10.100
P100 Geriatric oncology in India: A data on patient profile from one of the cancer centers in North India A. Vora⁎, S. Mukopadhyay, A. Upadhyay, V. Goyal, V. Kabra, G. Kadyapat, A. Roy, R. Singh Anupama Nehra Hooda, A.K. Anand, H. Chaturvedi. Department of Medical, Radiation and Surgical Oncology, Max Healthcare, New Delhi, India Introduction: This is the first attempt to look at the geriatric patients' profile visiting cancer center at our hospital in the last 1 year. Historically, geriatric patients were not included in clinical trials and also majority of the times were put into ‘supportive care only’, bracket. Lately, geriatric oncology is being recognized as a separate subspeciality. Materials and methods: In the last 1 year, all patients above 65 years, diagnosed with cancer and visiting our center, were evaluated. A proforma was filled, and analyzed. The tumor board was discussed with all patients and they were offered treatment depending on current standards and patients' performance status. Results: The total number of patients evaluated was 52. Male:female ratio was 16:36. Agewise distribution: N65 years: 52; N70 years: 22; N75 years: 7; N80 years: 3. Cancer sitewise distribution: lymphoma/
P. Caillet⁎1,2, S. Sebbagh3, J.-L. Lagrange4, M. Laurent1,2, C. Tournigand3, S. Culine5, E. Paillaud1,2 for the ELCAPA Study Group† 1 Department of Internal Medicine and Geriatrics, Geriatric Oncology Clinic, AP-HP, Henri Mondor Hospital, Créteil, France, 2Paris Est Créteil University (UPEC), LIC EA 4393, Créteil, France, 3Department of Medical Oncology, AP-HP, Henri-Mondor Hospital, Créteil, France, 4Department of Radiotherapy, AP-HP, Henri-Mondor Hospital, Créteil, France, 5Department of Medical Oncology, AP-HP, Saint Louis Hospital, Paris, † France, The ELCAPA Study Group was composed of three oncologists (S. Culine, C. Tournigand, and M. Chaubet), one radiotherapist (J.L. Lagrange), five geriatricians (P. Caillet, M. Laurent, E. Liuu, E. Paillaud and H. Vincent), two epidemiologists (F. Canouï-Poitrine and S. BastujiGarin), one pharmacist (M. Carvahlo-Verlinde), one bio-statistician (A. Le Thuaut), one medical doctor of clinical research (N. Reynald) and one assistant of clinical research associate(N. Boudjema). Purpose: To assess the feasibility of proposed anticancer treatments in 70 years and older men with prostate cancer. Patients and method: Retrospective descriptive study including 69 patients 70 years old and over referred in geriatric oncology consultation for an overall assessment in the context of the anticancer treatment plan. Collected data: demographics and comprehensive geriatric assessment data; tumor characteristics; noncompletion and toxicities of the different proposed anticancer treatments. Results: Sixty-nine patients were included (median age: 77 years (70–93 years)). 98.6% were diagnosed with prostate adenocarcinoma (one patient with neuroendocrin contingent). At the time of diagnosis, median PSA was 12.7 ng/ml (1.3–400), median Gleason score was 7 (6–10) and 11 patients (16.4%; 11/67) had metastases. Only 22 patients had an ECOG status of ≥2 (31.9%). The geriatric assessment revealed that 27.5% of the patients lived alone at home (n = 19). 26.1% of cases (n = 18) had one or more dependency for basic activities of daily living (ADL) and 44.9% of cases (n = 31) had fall risk. Nutritional status was impaired in 31.9% of cases (n = 22). Cognitive impairment and depressive syndrome were present respectively in 17.0% (8/47) and 19.4% (12/62) of cases. Hypertension and renal failure were the two main comorbidities respectively found in 58.0% and 44.6% (29/65) of cases. Among patients, 19 (27.5%) had surgical treatment: 13 radical prostatectomy (68.4%) and 6 endoscopic resection (31.6%), with only one complication (anastomotic stenosis after radical prostatectomy). Forty-two patients were treated with radiation therapy. The planned radiation therapy treatment has been fully competed in 92.9% of cases (39/40), with acute toxicity in 26 patients (68.4%; 26/38), mostly grades I and II (95.8%; 23/24). Among the 51 patients with an indication for first-line hormone therapy, 18 patients (36%) received a combination therapy for a median duration of 1 year (0.2–6.3 years). A maximum of four lines of hormone therapy per patient have been proposed and no safety problems have been reported.