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Letter to the Editor

Re: Jean-Pierre Droz, Gilles Albrand, Silke Gillessen, et al.

Management of Prostate Cancer in Elderly Patients:

Recommendations of a Task Force of the International

Society of Geriatric Oncology. Eur Urol. In press.

Health Assessment of the Elderly is a ‘‘Relatively Young’’


We would like to congratulate Droz et al


on their review

updating the 2014 International Society of Geriatric

Oncology guidelines on prostate cancer in men aged


70 yr. The authors analysed recent pertinent articles

with a focus on the importance of assessing overall health

status, comorbidities, and cognitive functions in personalis-

ing the management of prostate cancer in the elderly.

Interestingly, they introduced a more accurate preoperative

evaluation of the health status of these patients, and

stressed the importance of screening for cognitive function.

They confirmed the role of the Comprehensive Geriatric

Assessment in evaluating health status. It has been

demonstrated that this tool (including data on demograph-

ic, social, functional, nutritional, cognitive and mental

health status, presence of geriatric syndromes, and comor-

bidities) is very accurate in predicting both survival and

complications after various types of therapy, and may

consequently be very useful in differentiating ‘‘fit’’ and

‘‘frail’’ elderly patients, quantifying the balance between the

risks and benefits of each treatment.

As the above authors concluded, individual elderly

patients should be managed according to their health

status, and not according to their age.

Health assessment of the elderly in urology is a

‘‘relatively young’’ problem and until now there have been

few good studies in the literature. Reported analyses are

often limited to physical parameters and psychosocial

aspects, and only a few reports contain analyses of other

biochemical parameters, such as albumin, haemoglobin,

and creatinine values


. Despite the decision of the task

force to screen for malnutrition using only weight loss

during the last 3 mo, in our opinion these biochemical

parameters are essential in multifactorial analysis. Some

studies focusing on general surgery have found a correlation

between low albumin levels and postoperative complica-

tions, demonstrating that albumin is a marker of frailty


. The reasons for this are related not only to nutritional

status but also to the relationship between low albumin and

general inflammation or stress, and albumin may be an

indicator of a patient’s vulnerability



To confirm the negative impact of a low level of albumin

on health status, we would like to report results from a

prospective study by our department to evaluate the impact

of frailty on postoperative complications (unpublished

data). We analysed data for 78 elderly patients (


75 yr)

undergoing endoscopic or surgical urology procedures, and

found a significant correlation (



0.05) between low

albumin (dichotomization threshold 37 g/l) and major 30-d

postoperative complications (Clavien-Dindo grade 2).

We therefore believe that the inclusion of laboratory

values such as albumin, which may help to predict poor

outcomes, could provide essential extra information

regarding the health status of patients.

In conclusion, we very much hope that these biochemical

parameters will be included in all future prospective studies

on this issue to obtain a more complete picture of frailty in

elderly patients.

Conflicts of interest:

The authors have nothing to disclose.


[1] Droz J-P, Albrand G, Gillessen S, et al. Management of prostate

cancer in elderly patients: recommendations of a task force of the

International Society of Geriatric Oncology. Eur Urol. In press.


Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010;210: 901–8.

[3] Mogal H, Vermilion SA, Dodson R, et al. Modified frailty index

predicts morbidity and mortality after pancreaticoduodenectomy.

Ann Surg Oncol. In press. 5715-0.


Chang CC, Hsu CY, Chang TY, et al. Association between low-grade albuminuria and frailty among community-dwelling middle-aged and older people: a cross-sectional analysis from I-Lan Longitudinal Aging Study. Sci Rep 2016;6:1–9.


Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) e 1 5 0 – e 1 5 1

available at


journal homepage:

DOI of original article:




2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.