LAUSR

We are all aware of the world’s ageing population, a trend that is set to continue for decades ahead. The United Nations 2015 revision of their World Population Prospects report predicts that ‘‘globally, the number of persons aged 80 or over is projected to increase from 125 million in 2015 to 434 million in 2050’’ [1], representing a more than threefold increase. The number of people aged 65 yr in the European Union is expected to grow from approximately 84 million in 2008 to 141 million by 2050 [2]. We are also well aware that prostate cancer is a disease for which incidence increases with age. This combination means that prostate cancer among older men will represent an ever-increasing massive disease burden. It is therefore critical that the issue of how to manage prostate cancer in older men is properly addressed. Many fit and healthy older men are at risk of undertreatment because of an underestimation of their longevity, but others are equally at risk of overtreatment when comorbidities that predict a greater health risk than their prostate cancer are not taken into account. In this issue of European Urology, Droz et al [3] present a clinically practical update on the International Society of Geriatric Oncology (SIOG) guidelines for prostate cancer in men aged >70 yr. Previous SIOG guidelines on prostate cancer management for older men have been endorsed by the European Association of Urology (EAU) [4] and are incorporated in Section 6.7 of the EAU prostate cancer guidelines, which are freely available online. Perhaps the most important addition to these updated guidelines is the recommendation for cognitive function screening in this age group via the mini-COG test. This screening test is similar in diagnostic performance to the Mini Mental State Examination (MMSE) but is far less timeconsuming. Patients scoring <3 out of 5 require referral for a full assessment for dementia.