Age Matters in Prostate Cancer Treatment Decisions, Study Finds

When developing treatment plans for prostate cancer, physicians weigh many factors — and a new study suggests that chronological age should be one of them.

Research published October 28, 2025, in The New England Journal of Medicine Evidence found that age plays a key role in how men with metastatic hormone-sensitive prostate cancer (mHSPC) respond to intensified systemic therapies. The study was led by Daniel Spratt, MD, Chair of Radiation Oncology at University Hospitals Seidman Cancer Center and the Vincent K. Smith Chair in Radiation Oncology.

“Older men with prostate cancer are more likely to have cardiovascular disease and other health problems that can worsen with treatment,” Dr. Spratt explained. “We must never forget to treat the whole patient and not simply the disease.”

About one in three men with metastatic prostate cancer dies from causes other than their cancer, such as heart disease. Treatments like androgen deprivation therapy and androgen receptor pathway inhibitors (ARPIs) can increase risks of falls, fractures, cardiac complications, and even fatal adverse events.

The study analyzed data from more than 10,000 patients across multiple randomized phase 3 trials. It examined whether age affects the overall survival benefit of treatment intensification using ARPIs and/or chemotherapy.

“We observed an interaction between age and systemic treatment intensification on survival for men with mHSPC,” said Dr. Spratt. “Patients older than 70 with low-volume disease—especially those treated with radiotherapy to the primary tumor—did not see improved survival from adding intensified systemic therapy.”

The multinational study involved researchers from several institutions, including University Hospitals Seidman Cancer Center.