Potential gains from radical treatment of men with prostate cancer according to life expectancy.

Objectives: To investigate the impact of age and life expectancy on treatment decisions and its consequences for outcomes among men with intermediate and high-risk prostate cancer (PCa). Materials and methods: We studied men in Prostate Cancer data Base Sweden (PCBaSe) diagnosed between 2008 and 2022 with intermediate-risk or high-risk localized or locally advanced PCa and life expectancy between 2.5 and 15 years in the absence of PCa. Estimates of life expectancy were based on age and two comorbidity indices. Results: A total of 32 196 men were included in the analyses. Of these, 17 419 (54%) had a life expectancy between 10 and 15 years, of whom 11 147 (64%) received primary radical treatment. Age had a stronger influence than life expectancy on the selection of treatment. Around 10% of deaths within 10 years of diagnosis could potentially have been avoided if men with >10 years life expectancy, regardless of age, had received radical treatment, based on assumptions of high treatment efficacy (30% reduction in all-cause mortality) and high uptake of treatment (90%). Conclusion: A substantial proportion of healthy older men with intermediate and high-risk PCa did not undergo radical treatment. According to our model and assumptions, 10% of deaths within 10 years of diagnosis in these men could potentially have been avoided if they had received radical treatment.