What do prostate cancer patients die of?
BACKGROUND
A recent rise in the incidence of prostate cancer and a more favorable outcome have increased the proportions of other causes of death in affected men. Extending the survival of prostate cancer patients thus requires knowledge of all causes of death.


METHODS
Data on the population, cancers, and causes of death were gathered from the nationwide Swedish Family-Cancer Database. A Cox regression model, comparing prostate cancer patients with all other men, was applied. Hazard ratios (HR) were calculated both for the underlying cause and for dying with a specific cause listed among multiple causes of death.


RESULTS
Among 686,500 observed deaths, 62,500 were prostate cancer patients. For underlying causes other than prostate cancer, the highest cause-specific HRs were found for external causes (HR, 1.24; 95% confidence interval [CI], 1.16-1.31), diseases of the pulmonary circulation (HR, 1.22; 95% CI, 1.09-1.37), and heart failure (HR, 1.18; 95% CI, 1.11-1.24). For specific multiple causes, the highest HRs were found for anemia (HR, 2.28; 95% CI, 2.14-2.42), diseases of the pulmonary circulation (HR, 1.61; 95% CI, 1.55-1.68), and urinary system disease (HR, 1.90; 95% CI, 1.84-1.96).


CONCLUSIONS
Prostate cancer patients have a higher risk for dying from various causes other than prostate cancer, including external causes and heart failure. Mechanisms have been proposed linking these elevated risks to both cancer and treatment. More attention should be paid to comorbidities in men with prostate cancer. The present study fulfills a gap in the knowledge of death causes in prostate cancer patients.
Division of Molecular Genetic Epidemiology, German Cancer Research Centre DKFZ, Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany.
Matias
M
Riihimäki
Hauke
H
Thomsen
Andreas
A
Brandt
Jan
J
Sundquist
Kari
K
Hemminki
D000740:Anemia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015984:Causality; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity; D016001:Confidence Intervals; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000639:trends*; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods*; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D012306:Risk; D013548:Sweden / Q000453:epidemiology; D014570:Urologic Diseases / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
D017430:Prostate-Specific Antigen
J Gen Intern Med. 2009 Nov;24 Suppl 2:S389-94
19838837
Blood. 2007 Sep 15;110(6):1723-9
17496204
Int J Cancer. 2010 May 15;126(10):2259-67
19642094
PLoS Med. 2009 Dec;6(12):e1000197
20016838
Arch Intern Med. 2006 Jul 10;166(13):1380-8
16832003
Clin J Am Soc Nephrol. 2007 Sep;2(5):1008-13
17702737
Int J Epidemiol. 2000 Jun;29(3):495-502
10869322
Circulation. 2003 Jun 17;107(23 Suppl 1):I9-16
12814980
J Am Geriatr Soc. 2009 Jan;57(1):24-30
19054189
J Natl Cancer Inst. 2000 Apr 19;92(8):613-21
10772678
Clin Endocrinol (Oxf). 2002 Jun;56(6):779-86
12072048
Urol Int. 2008;81(4):389-93
19077397
Lancet Oncol. 2010 May;11(5):450-8
20395174
Int J Cancer. 2005 Jan 10;113(2):312-5
15386407
Epidemiology. 2006 Jan;17(1):100-3
16357601
BMJ. 1994 Apr 2;308(6933):891-4
8173368
Scand J Urol Nephrol. 2008;42(4):352-7
18609293
J Clin Endocrinol Metab. 2004 Dec;89(12):5898-907
15579733
J Clin Endocrinol Metab. 2008 Jun;93(6):2042-9
18349064
J Clin Oncol. 2009 Oct 10;27(29):4881-4
19738112
J Thromb Haemost. 2009 Apr;7(4):597-604
19143928
Eur J Neurol. 2009 Apr;16(4):488-92
19170740
Nat Rev Cancer. 2002 Aug;2(8):584-93
12154351
J Urol. 2003 May;169(5):1747-50
12686824
J Natl Cancer Inst. 2007 Dec 19;99(24):1881-7
18073376
Cancer. 1998 Sep 15;83(6):1180-8
9740084
Lancet. 1999 Jul 10;354(9173):93-9
10408483
Eur Urol. 2010 Mar;57(3):390-5
19914773
J Clin Endocrinol Metab. 2002 Feb;87(2):599-603
11836291
J Clin Oncol. 2006 Sep 20;24(27):4448-56
16983113