BACKGROUND: Guidelines recommend against treating localized prostate cancer (PCa) in men with a greater than 10-year life expectancy.
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However, physicians have difficulty accurately estimating life expectancy.
OBJECTIVE: We used data from a population-based observational study to develop a nomogram to estimate long-term other-cause mortality based on self-reported health status (SRHS), race/ethnicity, and age at diagnosis.
DESIGN: This was an observational study.
SUBJECTS: Men diagnosed with localized PCa from October 1994 through October 1995 participated in the study.
MAIN MEASURES: Initial measures obtained 6 months after diagnosis included sociodemographic and tumor characteristics, treatment, and a single item on the SRHS, with response options ranging from excellent to poor. We used Surveillance, Epidemiology, and End-Results program data to determine date and cause of death through December 2010. We estimated other-cause mortality with proportional hazards survival analyses, accounting for competing risks.
KEY RESULTS: We evaluated 2,695 men, of whom 74 % underwent aggressive therapy (surgery or radiotherapy). At the initial survey, 18 % reported excellent (E), 36 % very good (VG), 31 % good (G), and 15 % fair/poor (F/P) health. Healthier men were younger, and more likely to be white, better educated, and to undergo surgery. At follow-up, 44 % of the cohort had died; 78 % of deaths were from causes other than PCa. SRHS predicted other-cause mortality; for men reporting E, VG, G, F/P health, the cumulative incidences of other-cause mortality were 20 %, 29 %, 40 %, and 53 %, respectively, p < 0.001. Compared to a reference of excellent SRHS, multivariable hazard ratios (95 % CI) for other-cause mortality for men reporting VG, G, and F/P health were 1.22 (0.97-1.54), 1.73 (1.38-2.17), and 2.71 (2.11-3.48), respectively.
CONCLUSIONS: Responses to a one-item SRHS measure were strongly associated with other-cause mortality 15 years after PCa diagnosis. Men reporting fair/poor health had substantial risks for other-cause mortality, suggesting limited benefit for undergoing aggressive treatment. SRHS can be considered in supporting informed decision-making about PCa treatment.
Hoffman RM, Koyama T, Albertsen PC, Barry MJ, Daskivich TJ, Goodman M, Hamilton AS, Stanford JL, Stroup AM, Potosky AL, Penson DF. Are you the author?
University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA.
Reference: J Gen Intern Med. 2015 Feb 13. Epub ahead of print.