Abstract:
BACKGROUND:Limited data exist on long-term outcomes among men with prostate cancer (PCa) from population-based cohorts incorporating information on clinical risk category. OBJECTIVE:To assess 15-yr mortality for men with PCa treated with noncurative intent according to clinical stage, Gleason score (GS), serum levels of prostate specific antigen (PSA), comorbidity, and age. DESIGN, SETTING, AND PARTICIPANTS:Register-based cohort study of 76 437 cases in the National Prostate Cancer Register (NPCR) of Sweden diagnosed from 1991 through 2009 and treated with noncurative intent. Each case was placed in one of five risk categories: (1) low risk: T1-T2 tumor, PSA level <10 ng/ml, and GS ≤6; (2) intermediate risk: T1-T2 tumor and PSA level 10-<20 ng/ml or GS 7; (3) high risk: T3 tumor or PSA level 20-<50 ng/ml or GS ≥8; (4) regional metastases: N1 or T4 tumor or PSA level 50-100 ng/ml; and (5) distant metastases: M1 tumor or PSA ≥100 ng/ml. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Ten- and 15-yr cumulative risk of death after diagnosis from PCa, cardiovascular disease, and other causes. RESULTS AND LIMITATIONS:Among men with a Charlson Comorbidity Index (CCI) score of 0, no differences were found in observed versus expected all-cause mortality in the low-risk group. Observed mortality was only slightly greater in the intermediate-risk group, but men with high-risk localized PCa or more advanced disease had substantially higher mortality than expected. CCI was strongly associated with cumulative 10-yr mortality from causes other than PCa, especially for men <65 yr. Limitations include potential misclassification in risk category due to GS assignment. CONCLUSIONS:PCa mortality rates vary 10-fold according to risk category. The risk of death from causes other than PCa is most strongly related to comorbidity status in younger men.
journal_name
Eur Uroljournal_title
European urologyauthors
Rider JR,Sandin F,Andrén O,Wiklund P,Hugosson J,Stattin Pdoi
10.1016/j.eururo.2012.08.001subject
Has Abstractpub_date
2013-01-01 00:00:00pages
88-96issue
1eissn
0302-2838issn
1873-7560pii
S0302-2838(12)00925-6journal_volume
63pub_type
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