ORLANDO, FL USA (UroToday.com) - Due to the lead-time bias in the detection of prostate cancer, many older patients may succumb to other heath issues rather than to prostate cancer. This study sought to generate more accurate estimates of co-morbidity specific survival, stratified by patient age, tumor stage and tumor grade. They conducted a 10-year competing risk analysis of 19,639 men age 66 years and older identified in the Surveillance, Epidemiology and End Results (SEER) program linked to Medicare program data. Participants were diagnosed with localized prostate cancer and received active localized treatment within 180 days of diagnosis. Co-morbidity at diagnosis was classified using the Charlson co-morbidity index. Underlying causes of death were obtained from the SEER database.
She reported that during the first 10 years following diagnosis, patients with moderately and poorly differentiated prostate cancer were more likely to die from causes other than prostate cancer. Regarding men age 66-74 years, with stage T1c Gleason score 5-7 disease at diagnosis, 10-year overall mortality rates were 28.8%, 50.5%, 83.1%, respectively for men with Charlson scores 0, 1 and > 2. The corresponding prostate cancer specific rates were 4.8%, 2.0%, 5.3% respectively for men with Charlson scores 0, 1 and > 2. For men age 66-74 years with T1c Gleason score 8-10 disease at diagnosis, the corresponding rates were 55.0%, 52.0%, 64.3% and 25.7%, 20.2%, 13.7% respectively for men with Charlson scores 0, 1, > 2. The likelihood of death from competing medical hazards was roughly comparable for men with stage T2 disease, and higher for all men over age 75.
Dr. Lu-Yao concluded that co-morbidity specific data should be considered when estimating the likelihood of a man’s death from localized prostate cancer.
Presented by Grace Lu-Yao, PhD, MPH at the 2011 Genitourinary Cancers Symposium, Oral Abstract Session A: Prostate Cancer - February 17-19, 2011 - Orlando World Center Marriott, Orlando, Florida USA