Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study.

INTRODUCTION: Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS: PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS: A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION: In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.

[Preventing dependency in the elderly]. / Prevención de la dependencia en las personas mayores.

INTRODUCTION: Dependency, i.e. the need to depend on another person to perform activities of daily living, is the main concern and cause of suffering and poor quality of life in the elderly. The prevalence of dependency increases with age and is related to the presence of prior disease and fragility. Dependency is associated with increased morbidity, mortality and institutionalization, as well as with greater health and social resource utilization, all of which increases health costs. OBJECTIVE: To create a consensus document on the main health recommendations for the prevention of dependency in the elderly, based on the scientific evidence available to date, with the collaboration of scientific societies and public health administrations (the Spanish Ministry of Health, Autonomous Communities and Cities). METHODS: a) a preliminary consensus document was drafted by an expert group composed of representatives of various scientific societies and health administrations. This document was based on a review of the recommendations and guidelines published by the main organizations involved in health promotion and the prevention of disease, functional deterioration and dependency in the elderly; b) the consensus document was reviewed by the remaining experts assigned by the scientific societies and central and autonomous administrations; c) the final document was approved after a session in which the text was discussed and reviewed by all the experts participating in the working group (including the academic committee); d) the document was presented and discussed in the First National Conference on Prevention and Health Promotion in Clinical Practice in Spain. All participating experts signed a conflicts of interest statement. RESULTS: The document provides recommendations, with their grades of evidence, grouped in the following three categories: a) health promotion and disease prevention, with specific preventive activities for the elderly, including prevention of geriatric syndromes; b) prevention of functional deterioration, with clinical recommendations that can be applied in primary and specialized care; c) prevention of iatrogeny (drug prescription, inappropriate use of diagnostic and therapeutic modalities and healthcare). These recommendations were tailored to the characteristics of the older person (OP), categorized in five groups: healthy OP, OP with chronic disease, fragile or at risk OP, dependent OP, and OP at the end of life. CONCLUSION: These recommendations should be implemented by public health administrations to improve strategies for the prevention of dependency in the elderly in the xxi century.

[Sensory demyelinating polyneuropathology as a manifestation of paraneoplastic encephalomyelitis associated to adenocarcinoma of the prostate]. / Polineuropatia sensitiva desmielinizante como manifestación de encefalomielitis paraneoplásica asociada al adenocarcinoma de próstata.

INTRODUCTION: Different neurological disorders affecting different levels of the nervous system, both central and peripheral, are included among the paraneoplastic symptomologies of cancers, although their incidence is not well defined and varies according to the type of tumour. CASE REPORT: We report the case of a 73 year old male patient who was admitted with a suspected polyneuropathy that had been developing for one month. The diagnosis was confirmed by electromyography. The only probable aetiology found in the course of a specific exploration was an adenocarcinoma of the prostate, with a widespread distribution throughout the central ganglionic chains and bone metastases, which were observed by computerised tomography of the abdomino pelvic region and bone gammography, and had not previously been diagnosed. CONCLUSIONS: We reviewed the literature on the relation between neurological paraneoplastic syndromes and neoplasias that are not of a pulmonary origin and we found a low rate of association between the two processes. The relation between adenocarcinoma of the prostate and neurological paraneoplastic processes receives very little attention. These syndromes vary greatly in their neurological expression, and there is a link with different antibodies that could explain an etiopathogenic mechanism of an immunitary nature. No effective treatment exists in spite of its usually being aggressive and varied. The disease often progresses quickly and leads to death after a few months.