S. Gogov, MD, Department of Medicine, University Health Network, Toronto, ON.
Shabbir M.H. Alibhai, MD, MSc, FRCPC, Department of Medicine, University Health Network; Departments of Medicine and Health Policy, Management, and Evaluation, University of Toronto, ON.

Prostate cancer remains the most common malignancy in men. Screening remains controversial due to a lack of evidence from randomized trials that it decreases mortality. Treatment decisions are based on assigning patients to one of three risk groups (low, intermediate, or high) based on stage, tumour grade, and prostate-specific antigen level, and considering remaining patient life expectancy (affected by age and comorbidity). Men with low-risk disease can consider expectant management, surgery, or radiotherapy (either external beam or brachytherapy). In intermediate-risk patients, all options except expectant management are associated with excellent long-term survival. In high-risk patients, combining either radiation or surgery with androgen deprivation has emerged as the best option. There is no role for primary androgen deprivation for most patients.
Key words: prostate cancer, screening, treatment, surgery, radiotherapy.

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme

Christine B. Brezden-Masley, MD, PhD, Staff Physician, Department of Medicine, St. Michael’s Hospital; Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON.
Maureen Trudeau, BSc, MA, MD, Acting Regional Vice President, Cancer Services--Clinical; Head, Division of Medical Oncology/Hematology, Sunnybrook & Women’s College Hospital Sunnybrook Campus; Head, Systemic Therapy Program, Toronto Sunnybrook Regional Cancer Centre; Associate Professor, Department of Medicine, University of Toronto, Toronto, ON.

Breast cancer is the most common cause of cancer mortality in women over 65 years of age. Older women with breast cancer are usually understaged and undertreated as a result of factors such as significant patient comorbidities, patient preferences, age-biases, and poor cognition. Furthermore, women over the age of 70 have been excluded from many breast cancer clinical trials, making treatment conclusions difficult. Patients’ characteristics (including age and comorbidities) should be considered when deciding on the final treatment, a decision ideally made by both the treating physician and the patient. This review will discuss current treatment strategies for breast cancer patients, with a focus on the older population.
Key words: breast cancer, older adults, staging, systemic chemotherapy, radiotherapy.

Barbara-Ann Millar MB ChB, FRCR, Clinical Fellow, Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, ON.

Normand Laperriere MD, FRCPC, Associate Professor, Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, ON

Radiation therapy is commonly used in the management of intracranial malignancies. Although the effects on the developing brain have been extensively documented, the impact of this treatment modality on the older brain requires further investigation. The effect of radiation treatment, the intracranial lesion, and associated comorbidities and medications all influence the individual’s overall outcome. This review looks at the pathophysiology of radiation injury within the brain and its impact on cerebral irradiation in older patients.

Key words: radiotherapy, older brain, tumour, neurocognitive effects.

Michelle A. Ghert, MD, Clinical Fellow in Musculoskeletal Oncology, University of Toronto, ON, Mount Sinai Hospital, Toronto, ON. and Peter C. Ferguson, MD, MSc, FRCSC, Assistant Professor of Surgery, University of Toronto, Division of Orthopaedic Surgery, Mount Sinai Hospital, Department of Surgical Oncology, Princess Margaret
Hospital, Toronto, ON.

Primary bone and soft tissue tumours are rare in the general population. While bone malignancies in the geriatric age group are most often due to metastases or multiple myeloma, primary tumours can occur. These are treated with surgical resection and occasionally chemotherapy. Soft tissue sarcomas are more common and are usually treated with a combination of radiation and surgery. The outcome of treatment for bone sarcomas is poorer in the geriatric age group, but this is not true of soft tissue sarcomas. Patients with both primary bone and soft tissue malignancies should be referred to regional cancer centres for management.

Key words: sarcoma, surgery, radiotherapy, chemotherapy, cancer

Introduction
Musculoskeletal complaints are common in the geriatric population, but rarely are these complaints attributable to malignancies.

Jonathan A. Ship, DMD, Department of Oral Medicine and the Bluestone Center for Clinical Research; New York University College of Dentistry, New York, NY.

Saliva is critically important for oral and pharyngeal health. Xerostomic complaints and salivary hypofunction are common in older adults, producing impaired nutritional intake, host defence and communication. Salivary function remains remarkably intact in healthy older persons. Systemic diseases, medications and head and neck radiotherapy for cancer account for the majority of salivary disorders in the elderly. Diagnosis of the underlying phenomenon is critical before implementing therapy. Management strategies include replacement therapies and gustatory, masticatory and pharmacological stimulants. Prevention of the oral and pharyngeal sequelae of salivary hypofunction requires a multidisciplinary approach to stomatological care.
Key words: xerostomia, saliva, Sjögren's syndrome, salivary glands, radiotherapy.

E. Rand Simpson, MD, Associate Professor of Ophthalmology, University of Toronto; Director, Ocular Oncology, Princess Margaret Hospital, Toronto, ON.
Larry Ulanski II, MD, Ocular Oncology Fellow, University of Toronto, Princess Margaret Hospital, Toronto, ON.

Ocular malignancies in the elderly are often difficult to diagnose and manage. The five main cancers found in association with the eye are basal, squamous and sebaceous cell carcinomas, uveal melanoma and malignant cancers to the orbit. These include malignancies from breast, lung, GI, prostate and myelogenous proliferations. This article briefly reviews the most common forms of ocular cancer and brings the general practitioner up to date on the most current data from the Collaborative Ocular Melanoma Study (COMS). We use clinical photos to demonstrate specific clinical signs of cancerous disease. By maintaining a high level of suspicion when treating patients with acute visual symptoms, unnecessary morbidity and mortality may be avoided.
Key words: ophthalmology, cancer, radiotherapy, malignancy.