Predicting Survival in Men with Localized Prostate Cancer

With the recent release of updated prostate-specific antigen (PSA) screening guidelines by the American Urologic Association, all of the major professional societies have essentially acknowledged that our previous paradigm of widespread screening has led to overtreatment of patients and that a more measured approach is needed.

Now, investigators have conducted a population-based study that assessed the effect of age, tumor risk, and comorbidity on survival in 3183 men (age range, 60–89 years) with nonmetastatic prostate cancer who were identified from Surveillance, Epidemiology and End Results (SEER) registries. Comorbidity was assessed using a modified Charlson Comorbidity Index. Tumors were classified into low, intermediate, and high risk using standard definitions that accounted for PSA level, clinical stage, and Gleason score. Median follow-up was 14 years.

Fourteen-year other-cause mortality rates for patients with 0, 1, 2, and ≥3 comorbidities, were 24%, 33%, 46%, and 57%, respectively. For patients with ≥3 comorbidities, 10-year other-cause mortality rates for those aged ≤60 and ≥75 years at diagnosis were 26% and 71%. Prostate-cancer mortality rates for patients with low-risk and high-risk disease were 3% and 18%; prostate-cancer mortality associated with tumor risk was similar across age groups. The authors conclude that older patients with multiple comorbidities are at high risk for other-cause mortality within 10 years of diagnosis and that prostate-cancer mortality varies with disease risk. They also suggest that these data and conclusions do not inform screening decisions, and that decisions to screen or treat prostate cancer are separate entities.