The Role of Comorbidities in Treatment Decision-Making across the Spectrum of Prostate Cancer: A Podcast

Effective management of prostate cancer requires an approach that integrates oncological intent with careful consideration of coexisting comorbidities and functional reserve. This podcast explores how chronic health conditions, frailty and quality-of-life factors influence therapeutic choices across the disease continuum. In localised disease, long-term data demonstrating comparable survival between surgery, radiotherapy and active monitoring have reframed the rationale for radical intervention. Treatment decisions are now increasingly guided by competing health risks, anticipated life expectancy and patient preference. In advanced disease, treatment intensification with systemic combination therapy has extended survival but introduced new complexity. The cardiovascular, metabolic and cognitive toxicities of androgen deprivation therapy (ADT) necessitate individualised consideration of intermittent therapy or de-escalation for patients with substantial comorbidity. With the expanding use of triplet regimens in metastatic hormone-sensitive disease, assessing physiological rather than chronological age has become essential. The discussion further highlights the role of structured oncogeriatric assessment in optimising care. Tools such as the Rockwood Clinical Frailty Scale, G8 screening tool and comprehensive geriatric assessment (CGA) provide a systematic framework for evaluating frailty, polypharmacy, cognition and function, supporting balanced decisions about treatment escalation and supportive interventions. Collectively, the dialogue underscores a shift towards holistic, multidisciplinary decision-making that aligns cancer control with broader health, independence and wellbeing. Embedding frailty-informed assessment into prostate cancer pathways represents a necessary evolution towards truly personalised care. Podcast Video (MP4 314221 KB).