Pretreatment Predictors of Death from Other Causes in Men with Prostate Cancer
Published In: The Journal of Urology, v. 180, no. 6, Dec. 2008, p. 2447-2452
Posted on RAND.org on January 01, 2008
PURPOSE: Most men diagnosed with prostate cancer will die of other causes and pretreatment patient characteristics may identify those who are likely to die of other causes. Accurate stratification of patients by risk of other cause mortality may reduce needless treatment preventing morbidity and expense. MATERIALS AND METHODS: Using the CaPSUREi database a cohort of men was identified with clinically localized prostate cancer who had definitive treatment with radical prostatectomy or radiation therapy between 1995 and 2004. Pretreatment patient characteristics were evaluated to determine if early other cause mortality could be predicted. RESULTS: Of 13,124 subjects enrolled in CaPSURE 5,070 had clinical T1c-T3a prostatic adenocarcinoma treated with radical prostatectomy (77%) or radiation therapy (23%) and posttreatment followup data. Median followup was 3.3 years. The cohort was divided into 3 groups. The prostate cancer specific mortality group included 55 men (1%) who died of prostate cancer. The 296 men (6%) who died of causes other than prostate cancer comprised the other cause mortality group. A third group contained the 4,719 (93%) men surviving at the end of the observation period. Factors that exclusively predicted death from nonprostate cancer causes included age at diagnosis, having a high school education or less, high clinical risk, smoking at time of diagnosis, concurrent nonprostate malignancy and worse scores on the Short Form-36 Health Survey physical function scale. CONCLUSIONS: Several pretreatment patient characteristics may identify patients at high risk of nonprostate cancer mortality. Future studies should consider stratifying patients by or at least reporting these variables.