Irenaeus Sandra, Garmo Hans, Gedeborg Rolf, Ahlberg Mats, Robinson David, Stattin Pär, Beckmann Kerri
Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden.
Regional Cancer Center Midsweden Uppsala Sweden.
BJUI Compass. 2025 Sep 10;6(9):e70076. doi: 10.1002/bco2.70076. eCollection 2025 Sep.
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).
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.
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%).
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.
探讨年龄和预期寿命对中高危前列腺癌（PCa）男性治疗决策的影响及其对治疗结果的影响。
我们研究了瑞典前列腺癌数据库（PCBaSe）中2008年至2022年间诊断为中危或高危局限性或局部晚期PCa且在无PCa情况下预期寿命在2.5至15年之间的男性。预期寿命的估计基于年龄和两个合并症指数。
共有32196名男性纳入分析。其中，17419名（54%）预期寿命在10至15年之间，其中11147名（64%）接受了初次根治性治疗。年龄对治疗选择的影响比预期寿命更强。如果预期寿命>10年的男性，无论年龄大小，基于高治疗效果（全因死亡率降低30%）和高治疗接受率（90%）的假设接受根治性治疗，那么在诊断后10年内约10%的死亡可能可以避免。
相当一部分患有中高危PCa的健康老年男性未接受根治性治疗。根据我们的模型和假设，如果这些男性接受根治性治疗，那么在诊断后10年内10%的死亡可能可以避免。
