Making decisions is a part of life. Each day you face countless situations calling for conscious choice. Some are minor: what to have for breakfast, should you carry an umbrella, how you’ll use your time if a meeting is canceled. Others are major: buying a new home, making a career change, moving an aging parent into assisted living. The bigger the decision, the more information you need to gather.

There are two general categories of information. The first is factual. For example, a weather forecast predicts your umbrella need; or, after evaluating your savings and salary, you decide to move to an upscale area. The second category of information is more intuitive. It consists of judgment calls, such as the odds that you’ll really be happy if quit your secure job to follow your dream of becoming a writer.

The bigger the decision, the more you must gain as many facts as you can about your present situation, and balance those against future probabilities and expectations that you can’t know till you get there. If time is on your side, you can gather facts and imagine possibilities without pressure. Sometimes, however, an unforeseen circumstance demands accelerated fact-gathering and envisioning the future.

Prostate cancer diagnosis

A prostate cancer (PCa) diagnosis may strike unexpectedly, like a bolt out of the blue. However, if you’re one of the 85% of men who are diagnosed early with a relatively slow-growing disease, you have time to assemble the facts (PSA, multiparametric MRI, Gleason grade, cancer stage, etc.). You also have time to consider your future, and what quality of life you desire. As the information comes in, and you balance the facts with your wishes for the years ahead, you and your doctor will discuss treatments that are a good match for your disease and all your future considerations.

Life expectancy

There’s one aspect of the future, however, that is sobering to think about: given your general health and lifestyle, how long will you live? If you’re like most people, you go through each day without giving it much thought, but doctors are advised by national organizations and professional associations to take life expectancy and probable causes of death other than PCa into account when advising PCa patients about their choices. For instance, the National Comprehensive Cancer Network (NCCN) “…recommends that clinicians estimate patient other-cause life expectancy and incorporate these estimates into treatment decisions…”^[i]

This seems reasonable, but how many years of life you have ahead of you is hardly factual information. Instead, it’s a matter of probability calculated on many factors. One such calculator is an online tool called the Healthy Life Expectancy Calculator, developed by University of Connecticut’s Goldenson Center for Actuarial Research. Not only does it project how many years you’re likely to live, but how many of them will be unhealthy as you age. It’s based on 12 factors: gender, age, weight, height, education, annual income, exercise, your current health (including diabetes), diet, sleep smoking, driving history, and alcohol consumption. It may surprise you to know that there are life expectancy calculators specifically for men with PCa. A few of them also have an online tool, such as the one for overall life expectancy and risk of PCa death.

Another model (2022) has been proposed by a team of researchers out of University of Michigan and Case Western University.^[i] They developed an algorithm to predict other-cause mortality among PCa patients. How long are you likely to live and die of other causes than PCa? Their statistical probability is based on eight predictors: age, diabetes, education, high blood pressure, marital status, smoking status, previous stroke, and body mass index (BMI). Age was the strongest predictor, which makes sense since the older you are, the fewer years of life expectancy you have. More to the point, they analyzed the statistical interactions between age and each of diabetes, education, blood pressure, and previous stroke. They do not yet have an online tool, so we’ll be watching for one.

Why is life expectancy important in PCa treatment decisions?

The NCCN recommendation to take life expectancy into account underscores the value of matching the treatment not just to your prostate cancer, but to your age and general health as well. An aggressive treatment like radical prostatectomy reduces the likelihood of developing PCa metastasis, which is an incurable killer, but increases the chances of urinary and sexual side effects, so many patients feel like it’s a toss-up between quantity vs. quality of life. On the other hand, patients with slow-growing disease who have co-existing medical conditions such as cardiovascular disease or stroke history are more likely to die from non-cancer causes; such patients may not be candidates or wish to go through a major surgery; why put quality of life on the line during the years they have remaining? They may therefore decide on a less aggressive approach like Active Surveillance.

Fortunately, quantity vs. quality of life does not have to be an either-or decision. Our Center offers three focal therapy procedures that destroy tumor while preserving urinary and sexual function: Focal Laser Ablation (FLA), Exablate MRI-guided Focused Ultrasound, and TULSA-PRO. The success of focal treatment as a middle ground approach is well monitored by PSA blood tests and multiparametric MRI. All future treatment options are open should PCa recur. For those whose co-existing medical conditions rule out prostatectomy, focal treatment does not require general anesthesia and is kinder on the body than surgery. Recovery is fast, as well. If you’re interested in a treatment that contributes to both full life expectancy and lifestyle expectancy, contact us.

 

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] Chase EC, Bryant AK, Sun Y, Jackson WC, Spratt DE, Dess RT, Schipper MJ. Development and validation of a life expectancy calculator for US patients with prostate cancer. BJU Int. 2022 Apr 3.
[ii]Ibid.