Cohort study of overtreatment of prostate cancer among men with limited longevity in the active surveillance era

Men with limited life expectancy have historically been overtreated for prostate cancer. With increasing use of active surveillance, it is unclear of overtreatment of men with limited life expectancy has persisted. In a cohort study of 243,928 men with clinically localized prostate cancer in the Veterans Affairs health system between January 1, 2000, and December 31, 2019, overtreatment of low-risk prostate cancer with surgery or radiotherapy decreased, whereas overtreatment of men with limited life expectancy and intermediate-risk or high-risk disease increased, mainly with radiotherapy. The authors conclude that clinicians should avoid definitive treatment of men with limited life expectancy to prevent unnecessary toxic effects in men with unsufficient longevity to benefit from treatment.