Risk for prostate cancer-specific and other forms of mortality at 15 years of follow-up


An interesting study presented at the European Association of Urology meeting in Vienna recently documented risk for prostate cancer-specific and other forms of mortality within 15 years of diagnosis for Swedish men initially diagnosed with low- and intermediate-risk prostate cancer.

According to a write up by Evans on UroToday, the Swedish National Prostate Cancer Register (NPCR) contains data on a total of 106,958 cases of incident prostate cancer diagnosed in Sweden between 1991 and 2008, and NPCR includes more than 97 percent of all prostate cancer cases in the Swedish Cancer Register.

By linking personal identity data in the NPCR with data in the Swedish Cause of Death Register, the Patient Register, and the Census, Stattin et al. were able to correlate clinical outcomes to  date and cause of death, co-morbidity, and socioeconomic status. They were also able to calculate the accumulated 15-year risk of death from prostate cancer and competing causes for five highly characterized patient risk categories: low-risk, intermediate-risk, high-risk, regionally metastatic TxN1M0 (or PSA 50-100 ng/ml), and distant metastatic (TxNxM1) prostate cancer.

The key findings of the analysis showed that:

  • For men between 65 and 75 years of age at date of diagnosis with low-risk prostate cancer
    • Risk of prostate cancer-specific mortality within 15 years was 9 percent.
    • Risk of cardiovascular mortality within 15 years was 19 percent.
    • Risk of death from other causes was 25 percent.
  • For men between 65 and 75 years of age at diagnosis with intermediate-risk prostate cancer
    • Risk of prostate cancer-specific mortality within 15 years was 19 percent.
    • Risk of cardiovascular mortality within 15 years was 21 percent.
    • Risk of death from other causes was 25 percent.
  • There were strong increases in estimated, cumulative, 15-year prostate cancer-specific mortality with increasing risk category.
  • There was a continuous risk of prostate cancer-specific mortality throughout the follow-up period.

Stattin et al. concluded that outcomes for patients diagnosed with prostate cancer are “strongly related to risk category” and there is a continuous risk of prostate cancer-specific mortality up to 15 years after date of diagnosis.

Evans’s write up does not provide any detailed information on the risks for mortality among patients in the high-, regionally metastatic, and distant metastatic risk groups.

4 Responses

  1. The actual prostate cancer mortality in Sweden was 2,200+ per year during those years. A quick calculation gives us some 39,600 deaths of 110,027 diagnosis. That is a 36.0% death ratio. I wonder how he calculated those lower prostate cancer-specific death rates…

  2. Ralph:

    The vast majority of the men dying of prostate cancer in Sweden between 1991 and 2008 would have been diagnosed up to 20 years earlier. You cannot just divide the estimated number of men who died in that timeframe by the estimated number who were diagnosed. In addition, the data as reported deal only with patients diagnosed with low- and intermediate-risk disease.

  3. Mike,

    They reported that the diagnosed figure is 97% of those diagnosed during those years. The figure includes high-risk cases. I guess they ignored the high mortality of advanced prostate cancer to report the lower mortality of lower- or intermediate-risk disease. The point I tried to make is that when PSA is not available, disease-specific mortality is high.

    There is no reason not to divide deaths by number of diagnosis. It represents how aggressive the disease can be among other things of interest.

    Given the publicity given to the latest screening trials, men are either avoiding the test of their doctors are not offering it. Either case is a concerning issue to me.

  4. Ralph:

    Actually we don’t know what Stattin et al. reported when they presented these data. The only information we have is what Evans tells us that Stattin et al. reported. I haven’t seen any original data at all. This is all hearsay. At some point I would assume that Stattin et al. will publish a paper based on this analysis. At that point we may become better informed.

    While I understand your concern about under-diagnosis of prostate cancer, I do think we also need to balance that against the highly legitimate concern about over-treatment.

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