Age impacts systemic therapy outcomes in metastatic prostate cancer

Many things are evaluated when doctors are putting a treatment plan together for prostate cancer patients. A new study says one more factor should be considered – chronological age.

The study, published in the October 28, 2025 edition of New England Journal of Medicine Evidence, was led by senior author Daniel Spratt, MD, Chair Radiation Oncology at University Hospitals Seidman Cancer Center and Vincent K. Smith Chair in Radiation Oncology.

Older men with metastatic hormone-sensitive prostate cancer (mHSPC) are more likely to have comorbid medical conditions and die from causes other than pros­tate cancer. The study aimed to determine if age impacts the overall survival (OS) benefit from sys­temic treatment intensification (TI) with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy in mHSPC.

Older men with prostate cancer have a high incidence of cardiovascular disease and other comorbid conditions that can be exacerbated by common treatments, such as androgen deprivation therapy and ARPIs. Currently 1 in 3 men with metastatic prostate cancer die of causes other than prostate cancer, such as heart disease. Thus, "we must never forget to treat the whole patient and not simply the disease. Older patients who receive these therapies are more likely to experience falls, fractures, cardiac morbidity, and even grade 5 treatment associated adverse events" says Dr. Spratt.

We observed an interaction between age and systemic treatment intensification on survival for men with mHSPC. Patients older than 70 years old with low volume mHSPC, especially when treated with radiotherapy to the primary, did not demonstrate improvements from the addition of systemic treatment intensification."

Daniel Spratt, MD, Chair Radiation Oncology, University Hospitals Seidman Cancer Center 

This large study of over 10,000 patients included multiple randomized phase 3 trials of men with metastatic prostate cancer. This work was a multi-national collaborative study and included multiple other University Hospitals Seidman Cancer Center involved in the study are Angela Y. Jia, MD, PhD, Pedro Barata, MD, Nicholas G. Zaorsky, MD,  Jorge A. Garcia, MD,  Jason R. Brown, MD, PhD, and Soumyajit Roy, M.D., Prateek Mendiratta, MD.