When doctors create a treatment plan for prostate cancer, they typically consider factors like tumor type, spread, and overall health.
But a new study suggests one more factor deserves serious attention—chronological age. Researchers from University Hospitals Seidman Cancer Center have found that age can strongly influence how well patients respond to advanced treatments for metastatic prostate cancer.
The study, published in NEJM Evidence on October 28, 2025, was led by Dr. Daniel Spratt, Chair of Radiation Oncology at University Hospitals Seidman Cancer Center and the Vincent K. Smith Chair in Radiation Oncology.
His team examined how age affects treatment success in men with metastatic hormone-sensitive prostate cancer (mHSPC). This type of cancer means the disease has spread beyond the prostate but still responds to therapies that lower or block testosterone, a hormone that fuels cancer growth.
The researchers found that older men—especially those over 70—may not benefit as much from aggressive treatment combinations that include androgen receptor pathway inhibitors (ARPIs) and chemotherapy.
These treatments, often called systemic treatment intensification (TI), are meant to extend survival. However, older men tend to have other health problems such as cardiovascular disease, diabetes, or frailty, which may limit their ability to tolerate such intense therapy.
Prostate cancer is one of the most common cancers among men, particularly older men. Many patients live with the disease for years, but managing it becomes more complicated when age-related conditions come into play.
Currently, one in three men with metastatic prostate cancer dies from causes unrelated to cancer, such as heart disease or stroke. That means treatment decisions need to balance cancer control with the risks that come from therapy itself.
Dr. Spratt and his colleagues analyzed data from more than 10,000 patients across multiple randomized phase 3 clinical trials from around the world.
They discovered that the survival benefit of adding ARPIs or chemotherapy was smaller—or even absent—for men over 70 who had low-volume disease, meaning their cancer had spread less extensively. This was especially true for those who also received radiotherapy directed at the primary tumor.
“We must remember to treat the whole patient, not just the disease,” Dr. Spratt said. “Older patients who receive these therapies are more likely to experience falls, fractures, heart problems, or even fatal side effects. Sometimes, less can truly be more when it comes to treatment intensity.”
The findings underline a key shift in how doctors may approach prostate cancer treatment in aging populations. Traditionally, doctors have used a “one-size-fits-all” approach—offering the same combinations of hormone therapy, chemotherapy, and targeted drugs regardless of age.
This study challenges that model, showing that older patients may need a more personalized strategy that takes into account not only their cancer stage but also their overall health and life expectancy.
The research team, which included several co-authors such as Drs. Angela Jia, Pedro Barata, Nicholas Zaorsky, Jorge Garcia, Jason Brown, Soumyajit Roy, and Prateek Mendiratta, emphasized that the goal is not to withhold care from older patients but to make it safer and more effective for them.
They suggest that future clinical trials should better represent older adults and evaluate how treatments affect both survival and quality of life in this group.
This study offers an important reminder that age is more than just a number in cancer care—it’s a major factor that shapes treatment outcomes. While advanced therapies have extended survival for many patients, they also bring side effects that can outweigh their benefits for older individuals.
For men over 70 with low-volume metastatic prostate cancer, aggressive treatment may not add meaningful years of life and could even reduce quality of life.
These findings may encourage oncologists to adopt a more balanced approach—one that integrates cancer biology with geriatric medicine. Rather than focusing only on killing cancer cells, doctors may increasingly focus on preserving function, independence, and well-being.
As life expectancy continues to rise, personalized care for older cancer patients will become even more crucial.
The message from this research is clear: treating prostate cancer effectively means understanding the patient as a whole person, not just as a diagnosis. Age matters, and by considering it more carefully, doctors can help patients live not just longer, but better.
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The study is published in NEJM Evidence.
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