Other- and All-Cause Mortality Among Men Diagnosed with Prostate Cancer in the PLCO Trial.

Men with prostate cancer (PCa) have high cause-specific survival, and most deaths are of other causes. This study aimed to investigate other- and all-cause mortality in a large cancer screening cohort.

From the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial cohort, we selected men diagnosed with PCa from 1994-2014. We examined other- and all-cause survival by PCa risk level, defined as the D'Amico categories for localized disease (low-, intermediate- and high-risk) plus non-localized disease. We developed three Cox proportional hazards models to assess the relationship between risk level and survival. Model I controlled for age, race, study arm, and diagnosis year. Model II additionally controlled for other demographic and medical history factors; Model III additionally controlled for initial treatment.

Of 76,672 men in PLCO and 10,859 PCa cases, 9248 (85.2%) had known PCa risk level (mean (SD) age 70.4 (6.2) years). Median (25th/75th) follow-up time from diagnosis was 10.8 (6.8/15.0) years. Of 3318 deaths, 81% were from other-causes. Compared to the low-risk group, other-cause mortality HRs were 1.13 (95% CI: 1.04-1.23), 1.35 (95% CI: 1.21-1.50), and 1.63 (95% CI: 1.35-1.97), for intermediate-risk, high-risk, and advanced disease, respectively in Model II. Model III HRs were similar to Model II except for advanced disease, where the HR decreased to 1.35.

Other-cause survival was higher in lower compared to higher risk disease, even after controlling for lifestyle characteristics and comorbidities. Further research is needed to identify factors contributing to this higher other-cause mortality to help mitigate the risk.

The Journal of urology. 2020 Dec 22 [Epub ahead of print]

Dudith Pierre-Victor, Paul F Pinsky, Eric Miller, Howard Parnes

HCA Healthcare/USF Morsani College of Medicine Graduate Medical Education Programs, Tampa, Florida., Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.