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. 2015 Jan;85(1):92-100.
doi: 10.1016/j.urology.2014.07.003. Epub 2014 Sep 26.

Prediction of long-term other-cause mortality in men with early-stage prostate cancer: results from the Prostate Cancer Outcomes Study

Timothy J Daskivich  1 , Kang-Hsien Fan  2 , Tatsuki Koyama  2 , Peter C Albertsen  3 , Michael Goodman  4 , Ann S Hamilton  5 , Richard M Hoffman  6 , Janet L Stanford  7 , Antoinette M Stroup  8 , Mark S Litwin  9 , David F Penson  10
Affiliations

Prediction of long-term other-cause mortality in men with early-stage prostate cancer: results from the Prostate Cancer Outcomes Study

Timothy J Daskivich et al. Urology. 2015 Jan.

Abstract

Objective: To provide population-based estimates of other-cause mortality by age and comorbidity in men with prostate cancer for use at the point of care in shared decision making.

Materials and methods: We sampled 3183 men with nonmetastatic prostate cancer from the Prostate Cancer Outcomes Study, a US population-based prospective cohort. Survival analysis accounting for competing risks was used to provide predictions of other-cause and cancer-specific mortality by age, comorbidity, and tumor risk through 14 years of follow-up.

Results: Older men had a higher absolute risk of other-cause mortality associated with comorbidity. For men with comorbidity counts of 0, 1, 2, and 3+, cumulative incidence of other-cause mortality at 14 years was 9%, 18%, 30%, and 35% for those younger than 60 years; 26%, 26%, and 48%, and 52% for those aged 60-70 years; and 49%, 57%, 66%, and 74% for those older than 70 years. Prostate cancer mortality at 14 years was 5%, 8%, and 23% for men with low-, intermediate-, and high-risk disease. Competing risk pictograms for each age/comorbidity/tumor-risk pair provide visual characterization of these risks over time.

Conclusion: Our survival tables may be used at the point of care as part of shared decision making. Men aged >60 years with multiple comorbidities have substantial risk of other-cause mortality within 15 years of diagnosis and should consider conservative management for low-risk disease, given its low incidence of cancer-specific mortality. Men with high-risk disease, regardless of age or comorbidity, are at greater risk for cancer mortality and may still be appropriate candidates for aggressive treatment.

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Figures

Figure 1
Figure 1
A-B. Competing Risks Cumulative Incidence Curves for Overall, Other-cause, and Cancer-Specific Mortality by (a) Comorbidity Count and (b) D'Amico Tumor Risk
Figure 1
Figure 1
A-B. Competing Risks Cumulative Incidence Curves for Overall, Other-cause, and Cancer-Specific Mortality by (a) Comorbidity Count and (b) D'Amico Tumor Risk
Figure 2
Figure 2
Mortality by D'Amico Tumor Risk and Comorbidity Count, for Men Aged (a) < 60 years, (b) 60-70 years, and (c) > 70 years at Diagnosis.
Figure 2
Figure 2
Mortality by D'Amico Tumor Risk and Comorbidity Count, for Men Aged (a) < 60 years, (b) 60-70 years, and (c) > 70 years at Diagnosis.
Figure 2
Figure 2
Mortality by D'Amico Tumor Risk and Comorbidity Count, for Men Aged (a) < 60 years, (b) 60-70 years, and (c) > 70 years at Diagnosis.
See this image and copyright information in PMC

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