How do you approach systemic therapy for metastatic prostate cancer in geriatric patient when progressed to mCRPC on ADT alone?

This is an important question and requires a careful balancing of scientific and medical knowledge versus clinical skill.

(1) The first key issue is the context of the question -- what is meant by "frail", what has caused the "frailty", and what is the anticipated life expectancy of the patient. If the patient is frail because of intercurrent non-cancer disease, such as life-limiting ischemic heart disease, COPD, CVA's, CKD, and long-standing poorly controlled diabetes mellitus, I would be much ...

I agree with Dr. @Dr. First Last completely that the term 'geriatric' in oncology should not refer to actual age, but rather to physiologic measures of frailty and health, in order to avoid discrimination and withholding of life prolonging therapies unnecessarily based simply on age. The average age of diagnosis of prostate cancer is around 66 and the average age of death of men who develop mCRPC is in the late 70s, and thus the majority of men with prostate cancer are actually geriatric if we u...