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For a 63-year-old patient newly diagnosed with non-metastatic prostate cancer, expected survival varies significantly by management strategy, risk group, and comorbidities. The most robust comparative data come from randomized trials such as ProtecT and SPCG-4, as well as large cohort studies. Below is a summary table integrating key outcomes for the major management modalities, followed by a discussion of risk stratification and the impact of comorbidities.

Key points:

- Active monitoring/observation yields excellent long-term disease-specific survival for low-risk patients, with 10-year prostate cancer mortality [1][2][3][4]

- Radiation therapy (modern EBRT) provides similar long-term outcomes to surgery, with 10-year OS ~74–80% and disease-specific mortality [1][2][5][6]

- Surgery (radical prostatectomy) confers a mean of 2.9 years of life gained at 23 years in SPCG-4, with 10-year OS ~69% in older cohorts and ~78% in contemporary trials, and disease-specific mortality [1][2][4][7]

- Medical therapy alone (ADT) is associated with poorer overall survival, particularly in patients with limited life expectancy ([8]

- Combination therapy (Radiation + ADT) improves overall survival in high-risk patients, with 10-year OS up to 80%.[6][5]

Risk stratification and comorbidities:

- Survival outcomes are strongly influenced by risk group (low, intermediate, high), Gleason score, PSA, and comorbidities. For example, patients with Gleason ≥8, higher age, or significant comorbidities have worse OS regardless of treatment.[7][5]

- In the ProtecT trial, for men [1]

- Quality of life considerations and adverse effect profiles (urinary, sexual, bowel) are important in treatment selection.

Visual context:

The following table from the ProtecT 15-year outcomes study provides granular data on prostate cancer deaths by age, risk group, and treatment modality, illustrating the very low disease-specific mortality across all groups and the nuanced differences by age and risk.

This table demonstrates that, for men under 65, prostate cancer deaths at 15 years were 1.5% for active monitoring, 1.7% for surgery, and 2.9% for radiotherapy. For men ≥65, deaths were 5.9% for active monitoring, 3.0% for surgery, and 2.9% for radiotherapy. Stratification by Gleason grade, PSA, and risk scores further refines expected outcomes.

Summary:

For a 63-year-old with non-metastatic prostate cancer, expected 10- to 15-year overall survival is high (74–80%) with any definitive local therapy (surgery or radiation), and disease-specific mortality is low (Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. Hamdy FC, Donovan JL, Lane JA, et al. The New England Journal of Medicine. 2023;388(17):1547-1558. doi:10.1056/NEJMoa2214122.
2. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. Hamdy FC, Donovan JL, Lane JA, et al. The New England Journal of Medicine. 2016;375(15):1415-1424. doi:10.1056/NEJMoa1606220.
3. Radical Prostatectomy or Watchful Waiting in Prostate Cancer — 29-Year Follow-up. Bill-Axelson A, Holmberg L, Garmo H, et al. The New England Journal of Medicine. 2018;379(24):2319-2329. doi:10.1056/NEJMoa1807801.
4. Outcomes for Men With Clinically Nonmetastatic Prostate Carcinoma Managed With Radical Prostactectomy, External Beam Radiotherapy, or Expectant Management: A Retrospective Analysis. Barry MJ, Albertsen PC, Bagshaw MA, et al. Cancer. 2001;91(12):2302-14. doi:10.1002/1097-0142(20010615)91:123.3.co;2-g.
5. Prostate Cancer: A Review. Raychaudhuri R, Lin DW, Montgomery RB. JAMA. 2025;333(16):1433-1446. doi:10.1001/jama.2025.0228.
6. Effects on Life Expectancy of Treatment Decisions in Patients With Non-Metastatic Prostate Cancer. Tachibana A, Hori S, Nakai Y, et al. Anticancer Research. 2023;43(1):473-483. doi:10.21873/anticanres.16184.
7. Long-Term Overall Survival After External Beam Radiotherapy for Localised Prostate Cancer. Jahreiβ MC, Incrocci L, Dirkx M, et al. Clinical Oncology (Royal College of Radiologists (Great Britain)). 2023;35(12):e689-e698. doi:10.1016/j.clon.2023.09.017.
8. The Diagnosis and Treatment of Prostate Cancer: A Review. Litwin MS, Tan HJ. JAMA. 2017;317(24):2532-2542. doi:10.1001/jama.2017.7248.