As I write this, it’s spring. Spring is a time when the slumbering world of winter wakes up longer sunshine, warmer temperatures, new blossoms, and animal courtships. It’s a celebration of new life and renewed energy.

This year, spring brought me three new papers published in JAMA (Journal of the American Medical Association). They are all on life expectancy and prostate cancer (PCa). Rather than seeing life through the lens of its beginning, life expectancy focuses on the opposite: how long before you die. Given the time of year, it seems ironic.

I don’t intend this be a doom and gloom blog about death. In fact, it’s just the opposite, because each of the three papers deals with saving life. They examine radical prostatectomy (RP) performed as a definitive treatment performed with the intent to cure. Definitive means if the treatment succeeds, he’ll never need another one for PCa. However, for patients with intermediate-to-high-risk PCa, on average it takes 5-10 years (or more) after RP to know if they truly benefited from it.^[i] Ten years is a long time to start being truly relieved. Here are the issues.

One concern is probability as it relates to accurately diagnosing a patient’s risk level. It’s important to assess because there’s often a fine line between “definitive treatment of prostate cancer that is unlikely to require treatment or cause death if untreated.”^[ii] Another issue is the potential post-surgery risk of urinary incontinence and/or erectile dysfunction, be it temporary or permanent. A third problem is ensuring that the patient is a candidate for surgery based on his medical history and any possible co-existing conditions.

And, for this blog, their main issue is life expectancy. Did you know that there are guidelines for recommending RP based on how long a patient can expect to live? The standard is 10 years: if he is expected to die within 10 years he would be counseled against RP because it would be considered overtreatment—why put a man through an expensive surgery and risk side effects for his remaining years when something else is more likely to take his life? After all, death is not only due to natural aging, but also sooner from other diseases. For example, in 2022 the average life expectancy for U.S. men was 74.8 years. Thus, a 64-year-old man diagnosed with intermediate risk localized PCa would be offered RP as a definitive treatment option (along with other choices) whereas a 69-year-old with the same diagnosis would likely be discouraged from the surgery, especially if he had chronic kidney disease or lung cancer or any other condition expected to shorten his lifespan.

If it were you with intermediate-risk PCa, however, would you want your treatment decision based on national averages? Well, that’s where the guidance comes from. As noted in one of the papers, “… in population-based analyses, there will be a minority of patients that drastically outlive their estimated life expectancy and may derive meaningful benefit from treatment. Similarly, there will be men with longer life expectancy that do not live long enough to benefit from treatment. Yet, treatment decisions should be driven by evidence-based factors predicting when the vast majority of patients will or will not benefit from treatment.”^[iii]

I found one of the three papers particularly interesting because it compared overtreatment in two different aging populations: a) U.S. men (data from Veterans Administration records) and b) Swedish men (data from Sweden’s national health registry). Both have the same 10-year life expectancy guidelines. However, “a much higher proportion of VA men received radical therapy compared with men in Sweden.” The authors were unable to put their finger on exactly why this difference exists. They write, “The difference in treatment strategy between these 2 equal access health care systems is intriguing and warrants further investigation.”^[iv]

What you would do if it were you and you suddenly had to face two problems?

1. You have prostate cancer, with its high treatment success rate but no guarantee, and
2. You have to consider your life expectancy in choosing a treatment—and if you don’t, your doctor must certainly think about it to avoid overtreating or undertreating you.

Typically, the older we become, the more we ponder the reality of our mortality. Even without a cancer diagnosis, do you think about how many years you still have? Extending your life to its fullest potential is why so many of our blogs present key men’s health topics for reaching the full span of our lives with robust health and energy. Wellness choices include diet, exercise, stress management, supplements, positive social relationships, etc. We know that committing to health on all levels reduces the chances of developing prostate cancer—not to mention heart disease, diabetes, etc. And, if prostate cancer should occur, healthy patients have better treatment and recovery experiences. Finally, studies show that these same lifestyle habits can lower the chances of recurrence after treatment. This spring, celebrate your life by maximizing your life expectancy. You can do it!

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Daskivich TJ, Leppert JT. Overtreatment in Prostate Cancer: An Overused Term—Reply. JAMA Intern Med. Published online May 05, 2025. doi:10.1001/jamainternmed.2025.0319
[ii] Osinski T, Malshy K, Joseph J. Overtreatment in Prostate Cancer: An Overused Term. JAMA Intern Med. Published online May 05, 2025. doi:10.1001/jamainternmed.2025.0316
[iii] Daskivich et al, ibid.
[iv] Ventimiglia E, Gedeborg R, Styrke J et al. Radical Treatment for Prostate Cancer in Men With Limited Life Expectancy in Sweden. JAMA Netw Open. 2025;8(5):e258572. doi:10.1001/jamanetworkopen.2025.8572