Dr Scilipoti on the Value of Life Expectancy Assessments to Guide Prostate Cancer Treatment Strategies

We lack that [life expectancy assessment], which is a very important computing risk in these patients."

Pietro Scilipoti, MD, a clinical researcher at Ospedale San Raffaele, discussed long-term outcomes following guideline-recommended treatment for men with prostate cancer and how these findings could refine future management strategies.

Findings presented at the 2025 AUA Annual Meeting from a population-based analysis demonstrated that life expectancy assessment at diagnosis plays a crucial role in influencing treatment outcomes and competing risks of mortality. Scilipoti and colleagues utilized comorbidity scores derived from national registers in Sweden to more accurately estimate life expectancy, rather than relying solely on chronological age, which is commonly used in clinical practice. This analysis revealed that life expectancy was a primary determinant of other-cause mortality, which in turn indirectly affected prostate cancer–specific mortality risk.

According to Scilipoti, current guideline frameworks lack validated methods for assessing life expectancy in patients with prostate cancer, leading to potential overtreatment in more frail or older patients, or undertreatment in biologically younger but chronologically older patients. The study underscored the need for objective tools that incorporate comorbidities and biological age to better stratify patients at the time of diagnosis.

Importantly, the competing risk of non–cancer-related death was found to have significant implications for treatment selection. Patients with limited life expectancy due to comorbid conditions may derive limited benefit from aggressive prostate cancer therapies and could instead benefit from more conservative management strategies, Scilipoti noted.

Looking forward, Scilipoti emphasized that future research should focus on prospective validation of life expectancy models across diverse populations to ensure broad applicability. Additionally, clinical trials in prostate cancer should consider incorporating competing risk frameworks into study designs and end points, particularly when evaluating treatment strategies for older or comorbid populations.