Impact of Comorbidity on Survival Among Men With Localized Prostate Cancer

Purpose To provide patients and clinicians more accurate estimates of comorbidity-specific survival stratified by patient age, tumor stage, and tumor grade. Patients and Methods We conducted a 10-year competing risk analysis of 19,639 men 66 years of age and older identified by the Surveillance, Epidemiology, and End Results (SEER) program linked to Medicare program files. All men were diagnosed with localized prostate cancer and received no surgery or radiation within 180 days of diagnosis. The analysis was stratified by tumor grade and stage and by age and comorbidity at diagnosis classified using the Charlson comorbidity index. Underlying causes of death were obtained from SEER. Results During the first 10 years after diagnosis, men with moderately and poorly differentiated prostate cancer were more likely to die from causes other than their disease. Depending on patient age, Gleason score, and number of comorbidities present at diagnosis, 5-year overall mortality rates for men with stage T1c disease ranged from 11.7% (95% CI, 10.2% to 13.1%) to 65.7% (95% CI, 55.9% to 70.1%), and prostate cancer–specific mortality rates ranged from 1.1% (95% CI, 0.0% to 2.7%) to 16.3% (95% CI, 13.8% to 19.4%). Ten-year overall mortality rates ranged from 28.8% (95% CI, 25.3% to 32.6%) to 94.3% (95% CI, 87.4% to 100%), and prostate cancer–specific mortality rates ranged from 2.0% (95% CI, 0.0% to 5.3%) to 27.5% (95% CI, 21.5% to 36.5%). Conclusion Patients and clinicians should consider using comorbidity-specific data to estimate the threat posed by newly diagnosed localized prostate cancer and the threat posed by competing medical hazards.

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The Interval to Biochemical Failure Is Prognostic for Metastasis, Prostate Cancer-Specific Mortality, and Overall Mortality After Salvage Radiation Therapy for Prostate Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2013.02.016 ◽

2013 ◽

Vol 86 (3) ◽

pp. 554-561 ◽

Cited By ~ 12

Author(s):

Skyler Johnson ◽

William Jackson ◽

Darren Li ◽

Yeohan Song ◽

Corey Foster ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Biochemical Failure ◽

Salvage Radiation Therapy ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Overall Mortality

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Ten- and 15-year prostate cancer-specific survival in patients with nonmetastatic high-risk prostate cancer randomized to lifelong hormone treatment alone or combined with radiotherapy (SPCG VII).

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.4 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 4-4 ◽

Cited By ~ 1

Author(s):

Sophie D. Fossa ◽

Anders Widmark ◽

Olbjorn Harald Klepp ◽

Fredrik Wiklund ◽

Anders Angelsen ◽

...

Keyword(s):

Prostate Cancer ◽

Locally Advanced ◽

Hormonal Treatment ◽

Observation Time ◽

Cancer Specific Survival ◽

High Risk Prostate Cancer ◽

Specific Mortality ◽

Risk Prostate Cancer ◽

Cancer Specific Mortality ◽

Overall Mortality

4 Background: After a median observation time of 7.6 years, Scandinavian Prostate Cancer Group VII randomized trial showed a significant 12% reduction of prostate cancer-specific mortality in patients with locally advanced or histologically aggressive prostate cancer who received three months of total androgen blockade followed by radiotherapy and continuous antiandrogen therapy compared to patients with hormonal treatment only (Widmark et al :Lancet [2009]; 373,1174). Here we provide the 10 (15)-year survival results after a median observation time of 10.7 years. Methods: Between February 1996 and December 2002, 875 patients with locally advanced prostate cancer were randomized (Randomization ratio 1:1). Primary endpoint was prostate cancer-specific survival analyzed by intention to treat. This updated analysis is based on death registry data of the Norwegian patients (2/3 of the population), and on data recorded in CRF database available for the Swedish patients. A Swedish death registry analysis is underway, and will be included in the final analysis at the meeting. Results: Prostate cancer death occurred in 118 out of 439 of the antiandrogen treatment group and in 45 out of 436 men in the combination treatment group (p< 0.0001), with death due to any cause in 210 out of 439 and 161 out of 436 men (p=0.0006), respectively. The 10 (15) year cumulative prostate cancer-specific mortality was more than halved after combined treatment: 18.9% (30.7%) and 8.3% (12.4%) (HR=0.35;[p<4.1E-10 for 15 year results]), and overall mortality was 35.3% (56.7%) and 26.4% (43.4%) (HR=0.70; P=0.0006 for 15 year results), respectively. Conclusions: Addition of local radiotherapy to hormonal treatment in patients with non-metastatic locally advanced or high-risk prostate cancer more than halved the 10 and 15 year prostate cancer-specific mortality and substantially decreased overall mortality.

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Cancer-Specific Mortality After Surgery or Radiation for Patients With Clinically Localized Prostate Cancer Managed During the Prostate-Specific Antigen Era

Journal of Clinical Oncology ◽

10.1200/jco.2003.01.075 ◽

2003 ◽

Vol 21 (11) ◽

pp. 2163-2172 ◽

Cited By ~ 346

Author(s):

Anthony V. D’Amico ◽

Judd Moul ◽

Peter R. Carroll ◽

Leon Sun ◽

Deborah Lubeck ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Risk Groups ◽

The United States ◽

Localized Prostate Cancer ◽

Institutional Setting ◽

Psa Failure ◽

Specific Mortality ◽

Cancer Specific Mortality

Purpose: To determine whether pretreatment risk groups shown to predict time to prostate cancer–specific mortality (PCSM) after treatment at a single institution retained that ability in a multi-institutional setting. Patients and Methods: From 1988 to 2002, 7,316 patients treated in the United States at 44 institutions with either surgery (n = 4,946) or radiation (n = 2,370) for clinical stage T1c-2, N0 or NX, M0 prostate cancer made up the study cohort. A Cox regression analysis was performed to determine the ability of pretreatment risk groups to predict time to PCSM after treatment. The relative risk (RR) of PCSM and 95% confidence intervals (CIs) were calculated for the intermediate- and high-risk groups relative to the low-risk group. Results: Estimates of non-PCSM 8 years after prostate-specific antigen (PSA) failure were 4% v 15% (surgery versus radiation; Plog rank = .002) compared with 13% v 18% (surgery versus radiation; Plog rank = .35) for patients whose age at the time of PSA failure was less than 70 as compared with ≥ 70 years, respectively. The RR of PCSM after treatment for surgery-managed patients with high- or intermediate-risk disease was 14.2 (95% CI, 5.0 to 23.4; PCox < .0001) and 4.9 (95% CI, 1.7 to 8.1; PCox = .0037), respectively. These values were 14.3 (95% CI, 5.2 to 24.0; PCox < .0001) and 5.6 (95% CI, 2.0 to 9.3; PCox = .0012) for radiation-managed patients. Conclusion: This study provided evidence to support the prediction of time to PCSM after surgery or radiation on the basis of pretreatment risk groups for patients with clinically localized prostate cancer managed during the PSA era.

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The impact of comorbidity on survival among men with localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.8 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 8-8 ◽

Cited By ~ 1

Author(s):

G. L. Lu-Yao ◽

D. Moore ◽

W. Shih ◽

Y. Lin ◽

H. Li ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Tumor Grade ◽

Tumor Stage ◽

Localized Prostate Cancer ◽

Medicare Program ◽

Co Morbidity ◽

Underlying Causes ◽

Morbidity Index ◽

The Impact

8 Background: To provide patients and clinicians more accurate estimates of co-morbidity specific survival stratified by patient age, tumor stage and tumor grade. Methods: We conducted a ten year competing risk analysis of 19,639 men age 66 years and older identified by the Surveillance, Epidemiology and End Results (SEER) program linked to Medicare program files. All men were diagnosed with localized prostate cancer and received no surgery or radiation within 180 days of diagnosis. The analysis was stratified by tumor grade and stage and by age and co-morbidity at diagnosis classified using the Charlson co-morbidity index. Underlying causes of death were obtained from SEER. Results: During the first ten years following diagnosis men with moderately and poorly differentiated prostate cancer were more likely to die from causes other than their disease. For men age 66-74 years with stage T1c Gleason score 5-7 disease at diagnosis, ten year overall mortality rates and prostate cancer specific rates were 28.8%, 50.5%, 83.1% and 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. Death from competing medical hazards was roughly comparable for men with stage T2 disease and higher for all men over age 75. Conclusions: Patients and clinicians should consider using co-morbidity specific data to estimate the threat posed by localized prostate cancer. No significant financial relationships to disclose.

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Impact of marital status on prostate cancer-specific mortality and overall mortality after radical prostatectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.73 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 73-73

Author(s):

Kenneth Gerard Nepple ◽

Adam Stuart Kibel ◽

Gurdarshan S Sandhu ◽

Dorina Kallogjeri ◽

Seth A. Strope ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Marital Status ◽

Medical Comorbidity ◽

Never Married ◽

Increased Risk ◽

Married Men ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Overall Mortality

73 Background: Analysis from population-based cancer registry data has suggested that being married is associated with improved survival in men with prostate cancer. However, a limitation of such analysis is the inability to control for PSA or medical comorbidity which may differ by marital status. We investigated the association between marital status and both prostate cancer specific mortality (PCSM) and overall mortality (OM) in men treated with radical prostatectomy. Methods: The study population included 3596 men treated with radical prostatectomy at a single institution between 1994 and 2004 and followed for a median of 72 months. Disease specific factors (PSA, clinical stage, and biopsy Gleason grade), comorbidity (validated ACE-27 comorbidity index), ethnicity, age, and marital status at time of treatment were retrieved from an institutional cancer registry. Differences between marital status groups were evaluated by Chi square or ANOVA. Multivariable Cox proportional hazard regression models were used to estimate the hazard ratio (HR) of PCSM and OM by marital status. Results: 86.9% of men were married, 5.3% divorced, 2.4% widowed, and 5.5% never married. Marital status was associated with differences in PSA (p<0.01), comorbidity (p=0.04), and age (p<0.01). Married men had the lowest mean PSA at diagnosis and never married men were younger and the most likely to have no known medical comorbidity. A total of 386(11%) men were dead at the end of follow up, but only 55 of them died of prostate cancer. In multivariable analyses (Table), never married men had a significantly increased risk of PCSM and OM compared to married men, whereas no additional risk was observed for divorced or widowed men. Conclusions: Never married men had an increased risk of PCSM and OM. Factors associated with social isolation or unhealthy behaviors may have a detrimental effect on survival after prostatectomy. [Table: see text]

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Effectiveness of Primary Androgen-Deprivation Therapy for Clinically Localized Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2013.52.5782 ◽

2014 ◽

Vol 32 (13) ◽

pp. 1324-1330 ◽

Cited By ~ 50

Author(s):

Arnold L. Potosky ◽

Reina Haque ◽

Andrea E. Cassidy-Bushrow ◽

Marianne Ulcickas Yood ◽

Miao Jiang ◽

...

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation ◽

Localized Prostate Cancer ◽

Curative Intent ◽

Primary Androgen Deprivation Therapy ◽

All Cause Mortality ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Primary Androgen Deprivation

Purpose Primary androgen-deprivation therapy (PADT) is often used to treat clinically localized prostate cancer, but its effects on cause-specific and overall mortality have not been established. Given the widespread use of PADT and the potential risks of serious adverse effects, accurate mortality data are needed to inform treatment decisions. Methods We conducted a retrospective cohort study using comprehensive utilization and cancer registry data from three integrated health plans. All men were newly diagnosed with clinically localized prostate cancer. Men who were diagnosed between 1995 and 2008, were not treated with curative intent therapy, and received follow-up through December 2010 were included in the study (n = 15,170). We examined all-cause and prostate cancer-specific mortality as our main outcomes. We used Cox proportional hazards models with and without propensity score analysis. Results Overall, PADT was associated with neither a risk of all-cause mortality (hazard ratio [HR], 1.04; 95% CI, 0.97 to 1.11) nor prostate-cancer–specific mortality (HR, 1.03; 95% CI, 0.89 to 1.19) after adjusting for all sociodemographic and clinical characteristics. PADT was associated with decreased risk of all-cause mortality but not prostate-cancer–specific mortality. PADT was associated with decreased risk of all-cause mortality only among the subgroup of men with a high risk of cancer progression (HR, 0.88; 95% CI, 0.78 to 0.97). Conclusion We found no mortality benefit from PADT compared with no PADT for most men with clinically localized prostate cancer who did not receive curative intent therapy. Men with higher-risk disease may derive a small clinical benefit from PADT. Our study provides the best available contemporary evidence on the lack of survival benefit from PADT for most men with clinically localized prostate cancer.

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