Prostate Cancer in Older Men
Reviewed by: HU Medical Review Board | Last reviewed: June 2019 | Last updated: February 2023
The median age of prostate cancer diagnosis is 66 years old, with the highest proportion of those diagnosed between 65 and 74 years old, followed closely by those between 55 and 64 years old.1 Only about 10 percent of all prostate cancer cases are considered early-onset and affect men younger than 55 years old.2
The highest percentage of death due to prostate cancer is found amongst individuals between the ages of 75 and 84, followed very closely by those older than 85 years old.1 Unlike early-onset prostate cancer, later-onset prostate cancer is typically associated with both genetic and environmental factors (such as exposure to Agent Orange or smoking), as opposed to mainly genetic factors.4
How common is prostate cancer in older men?
Only 10 percent of prostate cancer cases are considered early-onset and occur before the age of 55 years old. The remaining 90 percent of cases occur in men older than this, and prostate cancer is considered the most common malignancy in the elderly population. It has even been estimated that roughly half of all men between 70 and 80 years old have microscopic evidence of the condition. The number of older men being diagnosed with prostate cancer is rising however, likely due to screening methods like the prostate-specific antigen (PSA) test, and a larger proportion of individuals being screened, as well as an increase in the life expectancy of the general population.
It has been estimated that by 2050, the percentage of individuals older than age 65 will increase four times in comparison to the year 2000. With a greater proportion of older individuals in the world, comes a greater amount of older men who can develop prostate cancer. For this reason, much research is ongoing to determine the best ways to treat men with prostate cancer of varying ages, including the elderly.1-3
What are the survival rates?
Many factors contribute to an individual’s prostate cancer prognosis including age, clinical stage, grade, comorbidities, PSA level, and response to treatment. Prostate cancer has incredibly high survival rates at the five, ten, and fifteen-year marks, and this is no exception when it comes to men of older age. Survival rates tend to decline very slightly for men roughly 85 and older, but this could also be due to potential life-shortening comorbidities. In fact, young men with aggressive prostate cancer are more likely than their older counterparts to experience prostate-cancer mortality, since many older men may have many other factors that contribute to mortality that come along with the natural aging process.
Prostate-cancer specific mortality is often regarded as being low enough in older men that treatment is typically less aggressive or may not be indicated at all. Aggressive or curative therapy may only be initiated when an individual has an estimated life expectancy of 10 years or more, as most treatment options can carry significant risks or side effects. For this reason, the older the individual, it is possible that they will be less likely to benefit from aggressive therapy. The quality of life impacts of many treatment options may not outweigh the potential gain in life expectancy. An individual who is older and frailer may not even be able to handle treatment and could end up living less time, but with significant quality of life deficits than if they had foregone treatment.
What are the concerns around treatment?
Not everyone with prostate cancer will develop aggressive and metastatic disease. For this reason, especially if an individual has any other serious health issues, or would not benefit as a whole from treatment, taking a watch and wait approach through active surveillance may be the best option. Although treatments like radical prostatectomies are associated with less adverse effects and long-term control of local prostate cancer, this is not always the case for individuals as they get older. If treatment is indicated for an older man, it will typically be conservative in nature, potentially including radiation therapy or androgen deprivation therapy (hormone therapy).
Further, since androgen deprivation therapy can carry significant side effects, like hot flashes, loss of libido, erectile dysfunction, osteoporosis (thinning bones), depression and mood issues, and potentially metabolic complications (high blood sugar, high cholesterol), some researchers have suggested that this type of treatment does not have to be continuous and can be performed intermittently for individuals who can’t handle the accompanying issues.
Your healthcare team will help determine the best course of action for your specific situation and case presentation. Very advanced prostate cancer may involve comfort care measures.2,4-5
What should I look for?
Regardless of age, prostate cancer often starts without warning signs until it has advanced further. This is why it is important to engage in appropriate screenings and talk with your provider regularly about your risk. When prostate cancer manifests, early symptoms include changes in urination, such as increased urgency and frequency of urination, blood in the urine or semen, interrupted or changed flow of urine stream, painful urination, erectile dysfunction, and pain in the pelvis, hips, thighs or lower back.