Treatment Options for Men 70 and Older with Prostate Cancer

By Winston Herbert

When a man over 70 is diagnosed with prostate cancer, the treatment options depend on how far the cancer has spread and how aggressive it is. There are two main situations: localized prostate cancer (cancer that is confined to the prostate gland) and advanced prostate cancer (cancer that has spread beyond the prostate or is very high-risk). Below is an overview of common treatment paths for each scenario, focusing on what they mean for older patients.

Localized Prostate Cancer Options

For cancer that is only in the prostate and has not spread, doctors have several ways to manage it:

• Active Surveillance (Close Monitoring): This is often recommended for small, slow-growing prostate cancers. The doctor will not treat the cancer right away. Instead, the patient gets regular check-ups, blood tests for PSA (a prostate cancer marker), scans, or maybe occasional small biopsies. The goal is to watch the cancer closely. If it shows signs of growing or becoming risky, then active treatment will start. Many men with low-risk tumors choose this path, especially if they are older. Active surveillance has become very common for low-risk prostate cancer because it helps men avoid or delay side effects of treatment​ sciencedaily.com. It’s important to note that active surveillance still involves routine monitoring; it’s not ignoring the cancer, but keeping a careful eye on it.

• Watchful Waiting: This is another form of monitoring, but it differs slightly from active surveillance. In watchful waiting, the approach is more passive. The patient does not undergo regular intensive testing. Instead, the medical team’s plan is simply to treat symptoms if and when they appear webmd.com. If the cancer is unlikely to shorten the patient’s life, there may be no need to subject the patient to treatments. Watchful waiting is often considered for older men with other serious health problems or a limited life expectancy, where the goal is to maintain quality of life rather than cure the cancer​ auanet.org. If the cancer eventually causes symptoms (like pain or blockage in urine flow), then palliative treatment is given to relieve those symptoms. We will discuss this in more detail later, but watchful waiting means holding off on any cancer-fighting treatment unless necessary.

• Surgery (Radical Prostatectomy): This is an aggressive treatment option for localized cancer. A surgeon removes the entire prostate gland (and sometimes nearby tissue). The goal is to cure the cancer by taking it out. Surgery can be very effective for cancers confined to the prostate. However, it comes with risks and side effects, especially for older men. The operation itself is major surgery, which can be tough on a senior’s body. Short-term risks include bleeding or complications with the heart or lungs during recovery​ pmc.ncbi.nlm.nih.gov. Longer-term side effects can include urinary incontinence (trouble controlling urine) and erectile dysfunction (difficulty with sexual function). These side effects are more common in men over 70 – for example, about 24% of men older than 70 have long-term incontinence after surgery, compared to 18% in men in their late 60s​. Doctors will carefully consider an older man’s overall health before recommending surgery. If a man is in his early 70s, very healthy, and has a tumor that looks aggressive, surgery might be offered as a curative option. On the other hand, if he is frail or has many other medical issues, surgery might pose too many risks for too little benefit.

• Radiation Therapy: Radiation is another aggressive treatment to kill or control the cancer. There are different forms of radiation (external beam radiation that targets the prostate from outside, or internal radiation “seeds” placed in the prostate, called brachytherapy). Radiation does not involve anesthesia or cutting the body, so some older patients who are not good candidates for surgery may choose radiation instead. It can be quite effective in curing or controlling localized prostate cancer. Like surgery, however, radiation can cause side effects. These can include tiredness, urinary problems (like needing to go often or irritation when urinating), bowel problems (such as loose stools or rectal irritation), and sexual dysfunction. In older men, radiation is often tolerated fairly well, but it usually requires coming for treatment many times (for example, external radiation is often given five days a week for several weeks). For a fit older man with a high-risk tumor, radiation can be a good option to try to stop the cancer, especially if surgery is not suitable. It’s worth noting that studies have found radiation plus short-term hormone therapy can help some older patients with higher-risk cancer live longer pmc.ncbi.nlm.nih.gov. Many men over 70 do receive radiation therapy for prostate cancer, sometimes even more often than younger men, because it’s a non-surgical approach.

• Hormone Therapy (Androgen Deprivation Therapy or ADT): For localized cancer, hormone therapy is not usually the first choice by itself. However, in some cases, doctors add hormone therapy to radiation treatment for intermediate or high-risk cancers, or use it alone if a patient cannot have surgery or radiation. Hormone therapy works by lowering testosterone and other male hormones that prostate cancer needs to grow pmc.ncbi.nlm.nih.gov. In an older man with a localized but aggressive tumor who cannot undergo surgery or radiation, hormone therapy might be used to slow the cancer’s growth. Hormone treatments can be injections or pills that reduce hormone levels. They can control cancer for a while, but they are not a cure by themselves. Also, hormone therapy has side effects that can be significant for older men, such as fatigue, weaker bones (risk of fractures), higher risk of diabetes or heart issues, hot flashes, and even memory or mood changes​. Doctors weigh these risks against the potential benefit of slowing the cancer.

• Others (Less Common Options): Sometimes other treatments like cryotherapy (freezing the tumor) or HIFU(high-intensity focused ultrasound) are considered, especially if the goal is to target the cancer with less invasive methods. However, these are less common and may not be widely available. For most older patients, the main choices boil down to those listed above or participation in clinical trials for new therapies.

In summary, for an older man with localized prostate cancer, the choices span from doing nothing aggressive at first (active surveillance or watchful waiting) to actively treating the cancer with surgery or radiation (often with curative intent). Each approach has pros and cons, especially in terms of side effects and the impact on quality of life. Many older men with low-risk cancers choose to monitor rather than treat immediately, since their cancer might never cause harm. Those with higher-risk cancers may lean towards treatment if they are healthy enough, since the cancer could shorten their life if left alone. The key is balancing the cancer’s threat against the man’s overall health and preferences.

Advanced Prostate Cancer Options

“Advanced” prostate cancer usually means the cancer has spread outside the prostate (to nearby tissues, lymph nodes, bones, or other organs) or that it is very likely to spread soon based on its aggressive features. In men over 70, advanced prostate cancer is often managed with treatments to control the disease and maintain quality of life, rather than to completely cure it (because once cancer has spread widely, cure is difficult). Here are common approaches for advanced cases:

• Hormone Therapy: This is the cornerstone of treatment for advanced prostate cancer at any age. As mentioned, hormone therapy (also called androgen deprivation therapy, or ADT) reduces the male hormones that fuel prostate cancer​ pmc.ncbi.nlm.nih.gov. In older patients, hormone therapy can shrink the cancer and slow its growth, often relieving symptoms like bone pain if the cancer is in the bones. Hormone therapy can keep the cancer in check for years in many cases. However, it is not permanent; eventually, the cancer can become resistant to it. Still, it can give an older patient several years of disease control. The side effects (fatigue, bone thinning, etc.) need to be managed. Doctors may also give calcium, vitamin D, or other drugs to protect bones. Hormone therapy is often the first-line treatment for advanced cancer because it’s effective and can be done with injections or pills without surgery.

• Chemotherapy: If the cancer stops responding to hormone therapy (a stage called castration-resistant prostate cancer), chemotherapy drugs like docetaxel may be used. Chemotherapy can kill or damage cancer cells throughout the body. It is more aggressive and has more side effects (such as lowering blood counts, causing hair loss, risk of infection, neuropathy, etc.). In an older man, the decision to use chemotherapy depends on his overall fitness and how aggressive the cancer is. Some men in their 70s tolerate chemotherapy well, especially if they are otherwise in good health. Others may have a hard time with it. It’s usually considered when hormone treatments are no longer enough, and the cancer is causing significant problems.

• Newer Targeted Therapies and Immunotherapies: Recently, new types of drugs have become available for advanced prostate cancer, such as PARP inhibitors (for those with certain genetic mutations) or immunotherapy vaccines. These are usually options after standard hormone therapy and chemo, and their use will depend on specific patient factors (like genetic testing results). For a 70+ patient, these might be considered if they are a candidate and if earlier treatments have been tried.

• Palliative Treatments: The word “palliative” means treatments aimed at relieving symptoms and improving comfort, rather than trying to eliminate the cancer. For advanced prostate cancer in an older man, there may be situations where the focus shifts to palliation. For example, if cancer has spread to the bones, targeted radiation to a painful bone spot can relieve pain. Pain medications might be used for comfort. If the tumor is blocking urine flow badly, a minor procedure or catheter might help. These supportive measures are very important in advanced stages, especially if aggressive treatments won’t prolong life much. The goal is to ensure the patient is comfortable and maintains dignity and quality of life.

Living with advanced prostate cancer in an older age requires balancing treatment benefit against side effects. Interestingly, one study found that even among men aged 65 to 84, those with the most advanced cancers were only slightly more likely to die of prostate cancer than of something else – heart disease was an even bigger killer in that group​. This shows that for many older men, other health issues still compete with cancer as a cause of death. Therefore, treating advanced cancer in an older person often involves a combination of systemic therapy (like hormones or chemo) and careful management of other health problems. The doctor might recommend a combination approach – for example, hormone therapy plus a short course of radiation to a tumor causing pain.

It’s important to know that even if a cancer is advanced, “watchful waiting” can sometimes still be a choice for an older man who has a very limited life expectancy or who strongly wishes to avoid the side effects of treatment. In that case, the medical team would focus purely on comfort measures. However, if the cancer is causing suffering, doctors will usually suggest some form of treatment to ease that, even if it’s just palliative.

Now that we’ve outlined the spectrum of treatments, from doing nothing aggressive to using multiple therapies, let’s clearly define what we mean by “aggressive treatment” versus “watchful waiting.”

Aggressive Treatment vs. Watchful Waiting – What Do These Mean?

These two terms describe opposite approaches to managing prostate cancer, especially in older patients. It’s important to understand them, because they represent the two ends of the decision spectrum.

• Aggressive Treatment: In simple terms, aggressive treatment means taking action against the cancer right away. This typically involves interventions intended to eliminate or control the cancer, such as surgery to remove the prostate, radiation therapy to destroy the tumor, or powerful medications like hormone therapy or chemotherapy. The word “aggressive” might sound scary, but here it just means the treatment is active and aimed at attacking the cancer head-on. The goal of aggressive treatment is often to cure the cancer or significantly extend life, especially if the cancer is likely to grow or spread. For a 70+ year-old man, aggressive treatment could mean a prostatectomy (if he is healthy enough for surgery) or a course of radiation. It could also mean combination therapy for advanced cancer. Aggressive treatments come with potential side effects, which we discussed earlier – these side effects can affect a person’s daily life (for example, trouble with urine control or sexual function after surgery, or fatigue and bone loss from hormone therapy). Doctors do not recommend aggressive treatment lightly in older patients; they usually do so when they believe the cancer poses a real threat to the patient’s life or well-being and when the patient is in sufficient health to tolerate the treatment.

• Watchful Waiting: Watchful waiting is essentially a plan of no immediate treatment. In watchful waiting, the idea is to observe the patient’s condition over time without active intervention for the cancer itself. Unlike active surveillance (which involves scheduled tests to monitor the tumor), watchful waiting is less structured. The patient will still see the doctor occasionally, and if symptoms from the cancer appear or worsen, then treatment is considered​. The main purpose of watchful waiting is to maintain quality of life. It is chosen when the prostate cancer is not currently a serious danger and is likely to remain slow-growing, especially if the man’s life expectancy is limited by age or other illnesses​ auanet.org. By avoiding or delaying treatments, the patient avoids side effects for as long as possible. If he never develops cancer symptoms, he might live the rest of his life without ever having undergone harsh cancer treatments. However, the downside is that the cancer is not being actively removed or killed – so if it does start to progress quickly, it might become a problem before treatment starts. Watchful waiting requires acceptance that the cancer is being left alone. Many older men are comfortable with this when they understand that the cancer is unlikely to harm them soon. Doctors often recommend watchful waiting to men in their 70s, 80s or beyond who have small, low-risk tumors or serious other health issues. In fact, clinical guidelines strongly support watchful waiting for men with very limited life expectancy (for example, less than 5 years) because treating the cancer would not make a difference in their survival in that time frame​. One expert panel noted that a patient likely needs to live at least 8-10 more years for aggressive treatment to show a survival benefit​. If that is not the case, watchful waiting is usually the wiser choice.

To put it another way, aggressive treatment is like fixing a problem immediately, while watchful waiting is like keeping an eye on a small problem and only fixing it if it starts getting big. Neither approach is “one size fits all.” The right choice depends on the cancer’s characteristics and the individual patient.

It’s also worth clarifying a related term: “active surveillance.” People often confuse active surveillance with watchful waiting because both avoid immediate treatment. The difference is that active surveillance involves regular monitoring tests (PSA tests, MRIs, biopsies, etc.) and is typically offered to men who could still be cured if the cancer starts to worsen, whereas watchful waiting usually implies that the patient will not undergo curative treatment and will only treat symptoms if they arise​. Active surveillance is common in younger men with low-risk prostate cancer (for example, a man in his 60s might undergo active surveillance, planning to have surgery later if needed)​. Watchful waiting is more common in older men – say a man in his late 70s with other health issues – where the plan is simply to keep him comfortable and not intervene unless absolutely necessary​ webmd.com. Both strategies avoid overtreatment, but the intent is slightly different.

Now that we have defined these terms let’s discuss how a man’s overall health and life expectancy play a critical role in choosing between aggressive treatment and watchful waiting.

The Impact of Health, Comorbidities, and Life Expectancy

Every patient is different. Two men who are 75 years old might have very different health profiles. One might be highly healthy – still active, with no major medical problems – while the other might have severe heart disease, diabetes, or other chronic conditions. Doctors refer to these other health conditions as comorbidities. They also consider something called life expectancy, which is an estimate of how many more years a person might live. These factors are crucial in prostate cancer decision-making for older men.

Why do health and life expectancy matter so much? The reason is that prostate cancer often grows slowly, especially the low-risk kind. It can take many years for it to become life-threatening (if it ever does). If a man is already in his 70s or 80s, one of the first questions the doctor asks is: “Is this cancer likely to cause problems in this man’s natural lifetime?” If the answer is no (because the man might unfortunately pass away from something else first, or the cancer is extremely slow-growing), then aggressive treatment might not be needed. On the other hand, if the man is likely to live another 10, 15, or even 20 years (some 70-year-olds are very healthy and could live well into their 80s or 90s) and the cancer is aggressive, then treating it could indeed help him live longer.

Guidelines often use a 10-year rule of thumb. Medical experts say that if a man is expected to live at least 10 more years, he should be offered the same treatment options as a younger patient​. In fact, “guidelines recommend offering treatment only to those who are expected to live 10 or more years, no matter what their age”​. The logic is that if you have a decade or more ahead of you, a cancer that might cause problems in 5-10 years is worth treating now. If you likely have less than a decade ahead, the cancer probably won’t get the chance to harm you in your remaining years, so aggressive treatment would be unnecessary.

Life expectancy is not just about age – it’s about overall health. One easy example: Imagine two men who are 70. One has been healthy, exercises, and has no major illnesses. The other has smoked his whole life and has bad heart and lung disease. Statistically, the second man may have a higher “biologic age” – his body might be more worn out and his chances of dying from a non-cancer illness are higher​. The healthy 70-year-old might have a life expectancy of 15 or more years, while the sick 70-year-old might have a life expectancy of only 5 years. So even though they are the same chronological age, the treatment recommendations could differ. The healthier man could benefit more from treating the prostate cancer, whereas the less healthy man might be harmed more by treatment than helped by it​.

Studies back this up. Research has shown that patients with life expectancy under 5 years do not benefit from prostate cancer screening or treatment, because it does not improve survival in that short time​. As mentioned earlier, one major study pointed out that you likely need a minimum of around 8–10 years of expected life for a prostate cancer treatment (like surgery) to translate into a chance of living longer​. If a man has serious comorbidities and a limited lifespan, his doctor will lean towards conservative management (active surveillance or watchful waiting)​. Watchful waiting is considered appropriate for elderly patients or those with significant comorbidities when their other health issues are more dangerous to them than the prostate cancer is​. In other words, if heart disease, for example, poses a bigger threat to life than the prostate tumor, it makes sense to avoid aggressive cancer treatments and focus on the more pressing health issues and on quality of life.

On the flip side, being older doesn’t automatically mean you shouldn’t treat the cancer. There is a real danger in assuming all older men should just “wait it out.” Some older gentlemen are in excellent health and have aggressive tumors that could indeed cut their life short. For these men, treatment should be considered despite their age. Medical experts note that many men aged 75 (for instance) might have a life expectancy that ranges widely – some might live only 5 more years, but others could live 14 years or longer​ pmc.ncbi.nlm.nih.gov. It’s not always easy to predict. Tools like the Charlson Comorbidity Index help doctors estimate how other health problems might impact survival​ pmc.ncbi.nlm.nih.gov  But there’s always some uncertainty.

Because of that uncertainty, doctors sometimes over-treat or under-treat older patients. Over-treatment means giving aggressive therapy to a patient who probably would have been fine without it. Under-treatment means not offering a potentially curative therapy to a patient who could have benefited. Both situations happen with prostate cancer in older men:

• Over-treatment example: A man in his late 70s with intermediate-risk prostate cancer and serious heart problems might still get surgery or intensive radiation, even though his odds of living long enough to benefit from that are low. A recent study highlighted this issue: increasing numbers of older U.S. men with intermediate- and high-risk prostate cancers (who have limited life expectancies) are undergoing treatments that may not extend their lives but do cause side effects that reduce their quality of life​ sciencedaily.com. The authors pointed out that many of these men “may not have life expectancies that would allow them to receive the benefits of more aggressive treatments”​. In their analysis, they found it troubling that men with very short life expectancies (less than 5 years) were being subjected to treatments that take up to a decade to show survival benefits​. This is a clear sign of over-treatment. The result can be unnecessary side effects – for instance, an older man might end up with urinary incontinence or bowel issues from radiation, without actually living any longer than if he had skipped treatment. Experts recommend against this practice. They say doctors and patients should carefully factor in life expectancy before deciding on aggressive therapy​.

• Under-treatment example: On the other hand, some older men who are very healthy and have dangerous cancers are not offered aggressive treatments due to age bias or fear of complications. There is evidence that prostate cancer is under-treated in patients aged ≥70 years despite potential benefits. A study from Canada found that about 15% of men with localized prostate cancer received “suboptimal treatment,” and the group most likely to be undertreated were healthy men over 70 with very aggressive tumors​ pmc.ncbi.nlm.nih.gov. In fact, among healthy older men with the highest-risk tumors (Gleason score > 8, indicating very aggressive cancer), about 72.7% did not receive curative treatment​. Many of these men were simply observed or given minimal therapy, and unfortunately, very aggressive cancer often leads to higher mortality if left untreated pmc.ncbi.nlm.nih.gov. This suggests that some doctors may shy away from recommending surgery or curative radiation to a 75-year-old even if his cancer is high-risk and he is otherwise in good health. The consequence might be a missed opportunity to control the cancer.

   

Both over- and under-treatment are problems. They highlight why a personalized approach is needed. Doctors and patients should discuss not just “How old are you?” but “What other health issues do you have?” and “How long might you live if we manage those issues well?” One prostate cancer expert, Dr. Timothy Daskivich, emphasizes integrating longevity into the discussion: the patient should understand the chance of dying from prostate cancer with treatment versus without treatment over his expected lifetime​. This kind of conversation helps tailor the decision to the individual.

In practical terms, if an older man has significant comorbidities (for example, severe COPD, uncontrolled diabetes, past strokes, etc.), the doctor may lean towards watchful waiting or just treating with hormones if needed. If an older man is spry and healthy, the doctor may treat the cancer more aggressively, similar to how they would for a 60-year-old. Always, the patient’s values matter too: some older individuals say, “I want to do everything possible to get rid of the cancer,” whereas others say, “I don’t want treatments that make me feel worse if I might not need them.” Both viewpoints are valid.

Next, let’s shift perspective a bit. We will consider what it’s like for seniors to navigate this decision and share insights from a patient advocate who has experience helping older prostate cancer patients.

Challenges Seniors Face in Making the Treatment Decision

Making a decision about cancer treatment is hard for anyone. For older men, there can be extra layers of complexity. As a patient advocate who has spoken with many prostate cancer patients in their 70s and 80s, I’ve observed several common challenges seniors face when deciding between aggressive treatment and watchful waiting:

1. Understanding Complex Information: Medical information about cancer can be overwhelming. There are statistics, medical terms, and various opinions from different doctors. Older patients may find it challenging to understand the likely outcomes of each option. For example, a doctor might say “Your cancer is low-grade and indolent” – words that might confuse someone not familiar with medical jargon. Seniors often need clear, plain language explanations (just like we are trying to do in this article!). They might hesitate to ask questions, or they might not catch everything during a fast-paced doctor’s appointment. This can lead to confusion or uncertainty about what to do. It’s important for healthcare providers and family members to take time to explain things in an easy way, and maybe even repeat key points. Written notes or pamphlets can help as memory aids. Many older patients also appreciate visual aids or analogies (for instance, comparing an aggressive cancer to a fast-growing weed versus a slow-growing cancer to a tree that barely grows – different growth rates needing different actions).

2. Emotional Stress and Anxiety: A cancer diagnosis at any age can cause fear and anxiety. Older men might react with thoughts like, “I’m too old for this” or “I knew something like this might happen as I aged, but I’m still scared.” Choosing watchful waiting can be emotionally challenging because it involves living with an untreated cancer. Some patients feel anxious, wondering, “Is the cancer growing? Am I making a mistake by not treating it?” This uncertainty is real. A study of men undergoing watchful waiting found that uncertainty and worry about the cancer are common feelings​ pubmed.ncbi.nlm.nih.gov. Patients develop coping strategies, but the psychological burden shouldn’t be underestimated. On the other hand, choosing aggressive treatment can also be stressful – the patient might worry about the surgery or radiation, the hospital stay, the recovery, and whether he’ll regain his continence or other functions. Seniors might also fear being a burden to their family during treatment or recovery. Managing these emotions is a big part of the journey. Support groups or counseling can be beneficial, and having open conversations with healthcare providers about fears is important. An empathetic doctor or nurse who acknowledges these worries can make a patient feel heard and more at ease.

3. Involving Family and Caregivers: Many men over 70 rely on spouses, children, or other family members to help make medical decisions. Family input can be both a blessing and a challenge. It’s a blessing because loved ones provide support, help research options, and often accompany the patient to appointments to help remember details. However, sometimes family members have strong opinions that might differ from what the patient wants. For example, an adult son might urge, “Dad, you should have the surgery. I want you to try everything,” while the dad is leaning towards not treating because he values his current quality of life and independence. Navigating these family dynamics requires good communication. As an advocate, I encourage families to listen to the patient’s wishes and priorities. It’s the patient who will live with the consequences (good or bad) of the decision. Families should provide input and support, but ultimately the choice should align with the patient’s values. Another challenge is when the patient himself has some cognitive decline (like early dementia) and isn’t able to fully understand the choices – in such cases, families and doctors have to work together to decide, always aiming for what the patient would have wanted. That can be ethically and emotionally tough.

4. Physical Limitations and Logistical Hurdles: Some older men have mobility issues or other physical limitations that make certain treatments harder. For instance, daily trips to a radiation center for 6-8 weeks might be very tiring or impractical if the patient can’t drive or doesn’t have easy transport. Surgery requires anesthesia and rehabilitation, which might be more difficult if a patient has frailty. Even coming to frequent doctor visits for active surveillance can be burdensome for someone who uses a walker or wheelchair, or who lives far away from the clinic. These practical issues sometimes push patients towards one decision or another. For example, I’ve known patients who chose radiation over surgery to avoid the intense recovery period of surgery. I’ve also seen patients choose watchful waiting because they simply couldn’t manage the frequent travel for treatment or had no one to help at home afterwards. Healthcare providers can often arrange support (transport services, home health visits, etc.), but it’s important that seniors voice these concerns. If getting to the hospital is a problem, there might be solutions like closer treatment centers or in-home services in some cases.

5. Balancing Quality of Life vs. Quantity of Life: Seniors often think deeply about whether they value living longer if it means living with certain side effects or limitations. A younger man might be willing to accept significant side effects to potentially add 20-30 years to his life. An older man, especially one who has lived a full life, might say, “I don’t want to spend my remaining years dealing with the fallout of treatment if it won’t make a big difference.” For example, sexual function might not be as big a concern for some 75-year-olds, but avoiding incontinence (needing to wear a diaper) could be a huge priority. Or maintaining independence (not being weak from treatments) could matter more than squeezing out a couple more years of life. These personal priorities weigh heavily. In my experience, some older patients feel guilt or pressure – as if they are doing something wrong by not treating the cancer. It’s important to reassure them that choosing comfort and quality of life is a valid decision. There is no “right or wrong” universally; it’s what is right for them. Physicians nowadays understand this and often support the patient’s preference after laying out the facts. An empathetic doctor will say something like, “We can treat this if you want to fight it, but if you’d prefer not to go through that, it’s okay to watch and wait – I will be here to make sure you’re comfortable either way.” That kind of reassurance helps seniors feel confident in their choice.

6. Financial and Social Considerations: While we won’t go deep into costs, it’s worth noting that some seniors worry about the cost of treatments or the burden on their insurance/Medicare or family finances. Treatments like surgery, radiation, and new medications can be expensive (though Medicare usually covers standard treatments). The time commitment and social impact (being away from home, not being able to take care of a spouse if they themselves are a caregiver) also play roles. Some older men are caregivers for their even older wives, for example – they might avoid intensive treatment because they need to be available for their spouse. These factors are very individual but certainly part of the decision puzzle.

In facing these challenges, the role of a patient advocate or nurse navigator is often to ensure the patient’s voice is heard and that they have all the information and support they need. As a seasoned advocate, my advice to families and care teams is: be patient, encourage questions, and ensure the older person doesn’t feel rushed or pushed into a decision. Sometimes taking a couple of extra consultations or getting a second opinion can ease the decision-making process. Seniors have the right to weigh their options at their own pace (as long as the cancer isn’t so aggressive that a delay would be dangerous, which is rarely the case for a few weeks of deliberation).

Now, with an understanding of these challenges, how can older patients and their families approach the decision in a practical way? Let’s go over some practical decision-making tips.

Practical Tips for Decision-Making (for Patients and Families)

Choosing between aggressive treatment and watchful waiting for prostate cancer is a personal decision. Here are some step-by-step tips and considerations to help men over 70 and their loved ones make an informed choice that feels right:

1. Learn About Your Specific Cancer: Ask the doctor to explain whether your cancer is low-risk, intermediate-risk, or high-risk. These categories depend on things like your PSA level, Gleason score (a grading of how aggressive the cancer cells look), and tumor stage. In simple terms, find out how likely is this cancer to grow or spread? If it’s the kind that grows very slowly, you might lean towards watchful waiting. If it’s more aggressive, you might consider treatment. Don’t worry about the technical terms as much as the bottom-line explanation from your doctor: is this a “turtle” cancer or a “rabbit” cancer? Low-risk “turtle” cancers move slowly and often safely watched​. High-risk “rabbit” cancers move faster and are more dangerous if not treated.

    

2. Honestly Evaluate Your Overall Health: Make a list of your other health issues. Include everything significant like heart conditions, lung disease, diabetes, past strokes, etc., and also consider your general fitness (can you walk a mile? do you need a cane or walker? do you get out of breath easily?). This helps gauge your biological age versus your numerical age. If you’re in great shape for 75, you probably have more years ahead to benefit from treatment. If you have multiple serious health problems, think about whether those might limit your life expectancy regardless of cancer. As one source puts it, “guidelines recommend offering treatment only to those who are expected to live 10 or more years”​. While it’s impossible to predict exactly how long someone will live, you and your doctor can discuss an estimate. If you likely have well over 10 years ahead, leaning towards treating the cancer (if it’s risky) makes more sense. If not, leaning towards watchful waiting might be wiser. Be frank in these discussions – it’s about getting a realistic picture.

    

3. Consider the Pros and Cons of Side Effects: Make sure you understand what side effects or lifestyle changes might come with each treatment. For surgery, will you be okay if you end up with urinary incontinence or need to use pads, even temporarily? For radiation, are you prepared for the possibility of bowel or urinary irritation and fatigue during treatment? For hormone therapy, do you know about the potential for fatigue, weight gain, or bone thinning? Understanding side effects is crucial because these affect your quality of life. Some men say, “I don’t care about side effects, I just want the cancer out.” Others say, “I value my current quality of life and don’t want it compromised if avoidable.” There’s no wrong answer – just personal preference. Make a simple list: what are you most afraid of – the cancer growing, or the treatment side effects? This can clarify your feelings. Remember, as one article noted, prostate cancer treatment in older people can sometimes “do more harm than good” if the person was likely to die of other causes first​. Weigh the harm-vs-benefit in your own case.

    

4. Seek a Second Opinion if Unsure: If you have any doubts, it’s perfectly okay (even common) to get a second opinion from another urologist or oncologist. Another doctor might explain things differently or confirm the first doctor’s recommendation. Sometimes hearing it twice helps it sink in. Also, different specialists might lean in different ways – for example, a surgeon might be more pro-surgery, whereas a radiation oncologist might offer radiation as an alternative. Hearing both perspectives can be valuable. Some patients over 70 also find it useful to talk with a geriatric oncologist (a specialist in treating cancer in older adults) if available, since they focus on balancing treatment with other health aspects in seniors. An informed patient is an empowered patient.

5. Include Your Family or a Trusted Friend: Bring a family member or friend to appointments to help listen and ask questions. Afterward, discuss with them what you understood. They might have caught something you missed. It’s important though that your voice remains central. Loved ones should support your wishes. Use them as a sounding board: talk through what you’re leaning towards and why. Sometimes articulating it out loud to someone helps clarify your own decision. If you have a spouse or partner, involve them deeply – this decision affects them too (for example, caregiving during treatment or dealing with side effects together). Make sure they understand what you value most. If you say, “I prefer quality of life even if it’s shorter,” that helps them understand why you might choose watchful waiting, and they can then back you up when talking with doctors.

6. Ask About Likely Outcomes for Your Case: A very practical tip is to ask your doctor something like, “What are the chances I will die from this cancer if we do nothing for now? And what are the chances I will have complications if we do treat it?” Essentially, compare the with-treatment and without-treatment scenarios. One research team encourages doctors to explain the likelihood of dying from the cancer with treatment versus without treatment over the patient’s expected lifespan​. This kind of comparison can make the decision more concrete. For example, if the doctor says, “Without treatment, there’s a 10% chance this cancer will cause you serious harm in the next 10 years. With treatment, that chance goes down to 3%, but you have a significant risk of side effects,” you can weigh those numbers. They might also say, “Given your health, even if we treat the cancer, something else is more likely to shorten your life first.” Hearing that can sometimes make the choice clearer.

7. Give Yourself Time (but Not Too Much Time): Take a little time to digest information and reflect on what you want. Prostate cancer (especially when caught early or if it’s low-risk) usually doesn’t require an emergency decision. It’s not like a heart attack where you need treatment today. If needed, you can spend a few weeks talking to doctors and family, reading reputable information, and contemplating. However, try not to procrastinate indefinitely. Aim to come to a decision in a timely manner (within a few weeks or a couple of months at most, depending on the situation) so that if you choose treatment, it can be started while it’s still effective. If you choose watchful waiting, you also want to start that plan (and any necessary follow-up scheduling) rather than avoiding the issue. Some older patients initially lean towards denial (“maybe I can just ignore this”) – that can be dangerous if the cancer is actually high-risk. So, do take the decision seriously. Mark a target date on your calendar by which you plan to decide, and use the time in between to gather info and reflect.

8. Consider Quality of Life Enhancements Regardless of Choice: Whether you pick aggressive treatment or watchful waiting, think about steps to maintain or improve your health and well-being. For instance, if you choose watchful waiting, you might focus on healthy lifestyle measures – balanced diet, exercise as you are able, and managing other health conditions optimally (to hopefully extend your life and keep the cancer slow-growing). If you choose treatment, perhaps look into pelvic floor therapy (to help with urinary control after prostate surgery) or support groups for men dealing with side effects. In both cases, staying as healthy as possible overall will improve outcomes. Remember, many men over 70 with prostate cancer die with the cancer, not from it​ – meaning the cancer often doesn’t get the chance to cause death. Keeping yourself healthy increases the odds that something else (at a much later age) ends up being the cause, not the prostate cancer. It’s a strange thing to say, but it’s actually a positive when an older man with prostate cancer eventually dies of non-cancer causes at a ripe old age – it means the cancer was managed well or truly slow-growing.

9. Use Empathy and Be Honest with Yourself: Finally, be kind to yourself in this process. It’s easy to second-guess or feel guilty no matter what you choose. If you opt for watchful waiting, you might worry “Am I being lazy or cowardly for not treating?” If you opt for treatment, you might later think “Did I rush into this and now I’m dealing with side effects for nothing?” These feelings are normal. Remind yourself that you made the best decision possible with the information available and your values in mind. Keep the communication open with your doctors – if watchful waiting is causing too much anxiety, you can always revisit the decision and choose treatment later. If treatment side effects are bothering you, tell your healthcare team; they often have ways to help manage them (physical therapy, medications, devices, or counseling). No path is without challenges, but staying engaged with your healthcare and support network will make the journey easier.

For men in their 70s and beyond, facing prostate cancer brings a very personal decision: Should I treat this cancer aggressively, or should I adopt a watch-and-wait approach? There is no one-size-fits-all answer. Aggressive treatments like surgery, radiation, or hormone therapy can offer the hope of controlling or curing the cancer, but they come with risks and side effects. Watchful waiting avoids immediate side effects and focuses on quality of life, but it means coexisting with the cancer and accepting some uncertainty. The right choice depends on the nature of the cancer, the man’s overall health and life expectancy, and the man’s own preferences and values.

What’s most important is that older patients feel empowered and supported in making this decision. The ongoing debate between aggressive treatment and watchful waiting is not about which is “better” in general, but which is better for a particular individual. A seasoned patient advocate will always say that the best decisions are made when patients are well-informed and their voices are heard. Seniors should know that doing nothing (immediately) is sometimes the medically sound choice – it’s not “giving up,” but rather a strategic decision to preserve quality of life when the cancer is unlikely to cause harm​. Conversely, choosing treatment at an older age is also valid when the cancer’s threat outweighs the treatment downsides and the patient is up for the fight.

In caring for an older man with prostate cancer, empathy and clarity go hand in hand. Doctors, patients, and families must communicate openly about goals and concerns. The tone of these conversations should be straightforward but compassionate – much like how we’ve tried to present information in this post. Remember, many men over 70 live many years with prostate cancer, and a large number will die of something else before prostate cancer ever causes issues​. This fact can be comforting. It means that in a great many cases, careful monitoring or minimal treatment is enough to ensure the cancer doesn’t interfere with living a fulfilling life.

Ultimately, whether the decision is to take immediate action or to watch and wait, it is the right decision if it aligns with the patient’s health needs and personal wishes. The goal is to treat the patient, not just the disease. That could mean aggressively treating the cancer in a robust 72-year-old with a fierce tumor, or it could mean treating the person by avoiding harsh therapies and letting him enjoy life with minimal medical interference. Prostate cancer care in older men is about finding that balance. With knowledge, support, and thoughtful consideration, men over 70 can feel confident choosing the path that is best for them in this chapter of life.

Sources: This article is informed by research and clinical guidelines on prostate cancer in older adults. Key references include studies showing that many older men with limited life expectancy do not benefit from aggressive treatment​ sciencedaily.com, as well as evidence that healthy older men with high-risk cancer may still gain from curative therapies​ pmc.ncbi.nlm.nih.gov. Clinical guidelines recommend watchful waiting for men with significant other health issues and less than 5-10 years of expected life​ auanet.org, while offering treatment to those likely to live longer than a decade​. Always discuss individual circumstances with a healthcare provider when making treatment decisions.