Why Age Matters When Treating Prostate Cancer

January 21, 2026

Doctors have always considered a man’s age when deciding how to treat prostate cancer. However, a new study suggests age may be even more important than previously thought.

A recent study found that some men aged 70 and older with metastatic prostate cancer didn’t live longer when they were given more aggressive treatment, like chemotherapy.

Many older men with prostate cancer also have other health problems, such as heart disease or diabetes. Prostate cancer treatments can aggravate these other conditions. In fact, about one in three men with metastatic prostate cancer dies from other causes.

Aggressive Treatment Doesn’t Help All Men

Prostate cancer is metastatic when it spreads to other parts of the body. The researchers looked at men with two types of metastatic hormone-sensitive prostate cancer (mHSPC): those with a small amount of spread and those with cancer that had spread more widely.

The study, published in the New England Journal of Medicine Evidence, found that men with cancer that hadn’t spread widely and received chemotherapy or a type of targeted therapy called androgen receptor pathway inhibitors (ARPIs) didn’t live longer than men without those treatments. “The research shows that not all older men with metastatic prostate cancer benefit from aggressive treatment following standard treatment,” says Daniel Spratt, MD, Chair Radiation Oncology at University Hospitals Seidman Cancer Center.

Quality of Life Matters

Aggressive cancer treatments can strongly affect the health and quality of life of all patients. In the case of some older patients, whose lives may not be extended or may be shortened by more aggressive treatments, they should be avoided because they’ll likely do more harm than good.

“Older patients who receive aggressive cancer treatments are more likely to experience falls, fractures, heart problems and even death,” says Dr. Spratt. “We should always strive to treat the whole patient, not just their cancer. In the case of older men with metastatic cancer whose disease hadn’t spread far, that involves carefully balancing the side effects and benefits of more aggressive treatment.”

Why Wasn’t Age Considered This Way Before?

In the past, metastatic prostate cancer was almost always fatal, so the primary goal of treatment was to extend life as much as possible. However, recent advances in diagnosis and treatment have improved the prognosis for men with metastatic prostate cancer. Now, preserving a man’s health and quality of life is as important as prolonging his life.

Should All Older Men Avoid Aggressive Treatment?

“It’s important to note that age is just a number,” says Dr. Spratt. “In assessing patients and determining the course of treatment, we also look at overall health, other medical conditions, how well patients can manage daily activities and other factors.”

Dr. Spratt notes that some older men with metastatic prostate cancer who are in excellent health may benefit from more aggressive treatment. However, on average, an 80-year-old man will have more health problems and a shorter life expectancy than the average 60-year-old man. Because of this, they are less likely to benefit from aggressive treatment.

Talking With Your Doctor

Dr. Spratt advises patients to speak up if their doctor simply recommends a “one-size-fits-all” treatment approach. If a treatment approach doesn’t seem tailored to your goals, your health and your cancer, he recommends seeking a second opinion to help ensure you receive the best personalized care.