With the exception of skin cancer, prostate cancer is the most common type of cancer in men in the U.S. In 2022, nearly 270,000 men will be diagnosed with prostate cancer, the American Cancer Society estimates.
The average age of diagnosis is 66. But as you get older, your chances of developing the disease go up. The questions of whether to screen for prostate cancer and whether to treat it become more complicated with age. And, if you’re older, the disease can be more deadly.
According to guidelines from the American Society of Clinical Oncologists, prostate cancer is more than twice as likely in people over 70 than in younger people. They’re also more than four times as likely to have advanced prostate cancer. And they’re more likely to die from the disease.
But keep in mind that age is just a number. While the risk goes up with each birthday, there’s no particular age at which prostate cancer becomes most dangerous. When you and your doctor discuss diagnosis and treatment options, the focus should not only be on your chronologic age -- the number of years you’ve been alive -- but on what’s called your biologic age.
Biologic age means, basically, how healthy you are now based on factors like your genes, lifestyle, and environment. Are you fit and otherwise healthy? Or do you have other illnesses that affect your overall health? This can help predict how long you’ll live in good health.
For example, two men who are both 70 years old are the same chronological age. But if one of them smoked all his life, his biologic age is probably higher. He has an increased risk of dying from smoking-related health problems like heart disease and lung disease.
A man with a lower biologic age may be more likely to benefit from prostate cancer treatment. In fact, guidelines recommend offering treatment only to those who are expected to live 10 or more years, no matter what their age. If they are, treatment decisions are the same as for younger people.
Should You Get Treatment for Prostate Cancer?
When you get a prostate cancer diagnosis, you have several options. You can get various types of treatment for your cancer, including hormone deprivation therapy, surgery, or radiation. Or you can go without it, at least at first.
Not everyone who’s diagnosed with prostate cancer will go on to develop symptoms that affect their lives. Due to screening tests, early diagnosis is common. But prostate cancer may not progress for years after you’re diagnosed.
Because prostate cancer often grows very slowly, older people are often more likely to die of other causes before it becomes a threat. In such cases, treatment may do more harm than good because of potential side effects, such as erection problems and incontinence. And the older you are, the more likely you are to have other medical problems, which can make surgery, for example, more risky.
If you’re at higher risk of dying from something other than prostate cancer, your doctor will likely recommend watchful waiting. That means they’ll address bothersome symptoms if and when they occur. The goal is to keep you comfortable and increase your quality of life, rather than to try to stop the disease itself.
If you’re younger and have a low-risk prostate cancer, your doctor may recommend active surveillance. As with watchful waiting, you won’t get immediate treatment. But you will have regular tests to be sure your cancer continues to grow slowly. If it does become aggressive, treatment may begin.
How Does Treatment Differ When You’re Older?
As you get older, your odds of developing chronic diseases such as heart disease and diabetes go up. That can make treatment decisions difficult. For example, hormone deprivation therapy (also called androgen suppression therapy) is commonly used to slow the growth of prostate cancer. It’s not a cure, but can keep the cancer from getting worse, at least for a while.
The problem: Some, though not all, studies show that it increases your risk of high blood pressure (hypertension), diabetes, heart disease, and stroke. It may even up your odds of dying from heart disease. Hormone deprivation therapy raises other concerns as well. It can weaken your bones (a condition called osteoporosis), which makes fractures more likely. It also can lead to problems with thinking. You and your doctor will have to weigh the risks of treatment against its potential benefits.
A 2008 study looked at more than 200,000 men with prostate cancer from ages 65 to 84. The researchers found that only men with the most advanced cases of prostate cancer were more likely to die of their cancer than another cause. Men in the study had a much greater chance of dying of heart failure than from late-stage prostate cancer.
If you’ve been diagnosed with prostate cancer, you should have a thorough discussion about the risks and benefits of watchful waiting or active surveillance with your doctor.
