Timothy J. Daskivich, MD; Kang-Hsien Fan, MS; Tatsuki Koyama, PhD; Peter C. Albertsen, MD; Michael Goodman, MD, MPH; Ann S. Hamilton, PhD; Richard M. Hoffman, MD, MPH; Janet L. Stanford, PhD, MPH; Antoinette M. Stroup, PhD; Mark S. Litwin, MD, MPH; David F. Penson, MD, MPH
Acknowledgment: The authors thank the men who participated in PCOS who, by their participation, have contributed to a better understanding of the effects of prostate cancer on men's lives; the physicians in the 6 SEER areas who assisted in the collection of data from their patients and from medical records; all of the study managers and chart abstractors for their outstanding efforts in data collection; and all of the staff in the 6 cancer registries for their help with the study.
Grant Support: By grant R01CA114524 from the National Cancer Institute of the National Institutes of Health. Dr. Daskivich is supported by grants from the Robert Wood Johnson Clinical Scholars Foundation, American Cancer Society, and American Urological Association.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1703.
Reproducible Research Statement: Study protocol: Detailed in the Methods section and available at the discretion of Dr. Penson. Statistical code: Available at the discretion of Dr. Penson. Data set: Restricted to members of the PCOS team and their designates.
Requests for Single Reprints: David F. Penson, MD, MPH, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37203-1738.
Current Author Addresses: Dr. Daskivich: Robert Wood Johnson Clinical Scholars, University of California, Los Angeles, 7th Floor, Suite 710, 10940 Wilshire Boulevard, Los Angeles, CA 90024.
Mr. Fan and Dr. Koyama: Vanderbilt University, 571 Preston Research Building, Nashville, TN 37232-6848.
Dr. Albertsen: Division of Urology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3955.
Dr. Goodman: Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322.
Dr. Hamilton: University of Southern California, Health Services Campus, SSB 318E, M/C 9239, Los Angeles, CA 90089-9239.
Dr. Hoffman: Department of Internal Medicine, New Mexico VA Health Care System, General Internal Medicine 111GIM, 1501 San Pedro Drive, SE, Albuquerque, NM 87108.
Dr. Stanford: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Box 358080 M4-B874, 1100 Fairview Avenue North, Building M, PO Box 19024, Mailstop M4-B874, Seattle, WA 98195-1024.
Dr. Stroup: Department of Clinical Epidemiology, University of Utah, Utah Cancer Registry, 650 Komas Drive, Suite 106B, Salt Lake City, UT 84108.
Dr. Litwin: Department of Urology, University of California, Los Angeles, Box 957383, 924 Westwood Boulevard, Suite 1000, Los Angeles, CA 90095-7383.
Dr. Penson: Vanderbilt University Medical Center, 2525 West End Avenue, Suite 600, Nashville, TN 37203-1738.
Author Contributions: Conception and design: T.J. Daskivich, P.C. Albertsen, R.M. Hoffman, J.L. Stanford, A.M. Stroup, M.S. Litwin, D.F. Penson.
Analysis and interpretation of the data: T.J. Daskivich, K.H. Fan, T. Koyama, P.C. Albertsen, J.L. Stanford, A.M. Stroup, M.S. Litwin, D.F. Penson.
Drafting of the article: T.J. Daskivich, T. Koyama, A.M. Stroup, D.F. Penson.
Critical revision of the article for important intellectual content: T.J. Daskivich, T. Koyama, P.C. Albertsen, M. Goodman, A.S. Hamilton, R.M. Hoffman, J.L. Stanford, M.S. Litwin, D.F. Penson.
Final approval of the article: T.J. Daskivich, P.C. Albertsen, M. Goodman, A.S. Hamilton, R.M. Hoffman, J.L. Stanford, A.M. Stroup, M.S. Litwin, D.F. Penson.
Provision of study materials or patients: A.S. Hamilton, J.L. Stanford, A.M. Stroup.
Statistical expertise: K.H. Fan, T. Koyama, M.S. Litwin.
Obtaining of funding: P.C. Albertsen, J.L. Stanford, M.S. Litwin, D.F. Penson.
Administrative, technical, or logistic support: M. Goodman, J.L. Stanford, A.M. Stroup, M.S. Litwin, D.F. Penson.
Collection and assembly of data: P.C. Albertsen, M. Goodman, A.S. Hamilton, R.M. Hoffman, J.L. Stanford, A.M. Stroup, D.F. Penson.
Accurate estimation of life expectancy is essential to offering appropriate care to men with early-stage prostate cancer, but mortality risks associated with comorbidity are poorly defined.
To determine the effect of age, comorbidity, and tumor risk on other-cause and prostate cancer–specific mortality in men with early-stage disease.
Prospective cohort study.
A nationally representative, population-based cohort.
3183 men with nonmetastatic prostate cancer at diagnosis.
Baseline self-reported comorbidity (scored as a count of 12 major comorbid conditions), tumor characteristics, initial treatment, and overall and disease-specific mortality through 14 years of follow-up. Survival analyses that accounted for competing risks were performed.
Fourteen-year cumulative other-cause mortality rates were 24%, 33%, 46%, and 57% for men with 0, 1, 2, and 3 or more comorbid conditions, respectively. For men diagnosed at age 65 years, subhazard ratios for other-cause mortality among those with 1, 2, or 3 or more comorbid conditions (vs. none) were 1.2 (95% CI, 1.0 to 1.4), 1.7 (CI, 1.4 to 2.0), and 2.4 (CI, 2.0 to 2.8), respectively. Among men with 3 or more comorbid conditions, 10-year other-cause mortality rates were 26%, 40%, and 71% for those aged 60 years or younger, 61 to 74 years, and 75 years or older at diagnosis, respectively. Prostate cancer–specific mortality was minimal in patients with low-risk (3%) and intermediate-risk (7%) disease but appreciable in those with high-risk disease (18%) and did not vary by number of comorbid conditions (10% to 11% in all groups).
Comorbid conditions were self-reported.
Older men with multiple major comorbid conditions are at high risk for other-cause mortality within 10 years of diagnosis and should consider this information when deciding between conservative management and aggressive treatment for low- or intermediate-risk prostate cancer.
National Cancer Institute.
Timothy J. Daskivich, Kang-Hsien Fan, Tatsuki Koyama, Peter C. Albertsen, Michael Goodman, Ann S. Hamilton, et al. Effect of Age, Tumor Risk, and Comorbidity on Competing Risks for Survival in a U.S. Population–Based Cohort of Men With Prostate Cancer. Ann Intern Med. 2013;158:709–717. doi: 10.7326/0003-4819-158-10-201305210-00005
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Published: Ann Intern Med. 2013;158(10):709-717.
Hematology/Oncology, Prostate Cancer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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