Due to the high incidence and prevalence in older men, prostate cancer is best understood as an age-associated disease. Physicians and their older patients commonly face the dilemma of whether or not to initiate treatment for localized disease or early systemic relapse (ie, biochemical recurrence). Although many older men with symptomatic advanced prostate cancer benefit from hormonal treatments and chemotherapies, treatment complications also may influence outcome. Older prostate cancer patients have a high prevalence of other factors that can limit remaining life expectancy (RLE), quality of life (QOL), and tolerance to treatment. A comprehensive geriatric assessment (CGA) can help identify other health status issues that can predict morbidity or mortality in vulnerable or frail older prostate cancer populations. Despite a growing body of evidence, more research is needed to establish optimal treatment strategies for all disease stages in prostate cancer patients diagnosed later in life.