Treatment choices in early-stage prostate cancer

When assessing a suspected localized tumor (restricted to the area of origin) and making a decison on which type of therapy is suitable, one must not only take the aggressiveness of the tumor into account. In the case of a slow-growing tumor such as a prostate carcinoma, which has been diagnosed at an early stage, the estimated life expectancy of the patient is also an important consideration. 

Local treatment, such as surgery or radiation therapy, could be the treatment of choice if the estimated life expectancy of men with tumors discovered at an early stage is greater than 15 years, and in the case of aggressive tumors, greater than 10 years. Conversely, active monitoring is meaningful when the estimated life expectancy is less than 15 or 10 years. Why is this? The reason is that there is great likelihood that none of the medical problems associated with prostrate cancer are expected to develop within this period. However, this approximate guideline should only be taken into account after a doctor has assessed the individual patient's state of health. 

What does this mean in concrete terms? Surgery is more frequently indicated in younger patients. De facto, almost 80% of the patients operated on at the Martini-Klinik are under the age of 69 years and about 20% are between the ages of 70 and 75 years.

How is life expectancy calcluated?

The Max Planck Institute Rostock specializes in demographic research and has published the following statistics:

Patient age at diagnosis 657075
A   Average future life expectancy Ø in years16.9413.3710.17
B   Average future life expectancy of the healthiest  25%  24.420.115.1

Row A shows the average figure for all men, independent of their general state of health. The statistics in Row B show the men among the healthiest 25% who live longer and  reach an average age of about 90 years. Your own life expectancy can, of course, only be assessed in consultation with a doctor. 

There are tests that can give you an indication of your life expectancy, in which your biological age is calculated. If the test result arrives at a biological age lower than your actual age, you may assume a longer average life expectancy than shown in Row A.