title: Impact of comorbidity on survival among men with localized prostate cancer.
abstract: OBJECTIVE
  To provide patients and clinicians more accurate estimates of comorbidity-specific survival stratified by patient age, tumor stage, and tumor grade.
  
  
  METHODS
  We conducted a 10-year competing risk analysis of 19,639 men 66 years of age and older identified by the Surveillance, Epidemiology, and End Results (SEER) program linked to Medicare program files. All men were diagnosed with localized prostate cancer and received no surgery or radiation within 180 days of diagnosis. The analysis was stratified by tumor grade and stage and by age and comorbidity at diagnosis classified using the Charlson comorbidity index. Underlying causes of death were obtained from SEER.
  
  
  RESULTS
  During the first 10 years after diagnosis, men with moderately and poorly differentiated prostate cancer were more likely to die from causes other than their disease. Depending on patient age, Gleason score, and number of comorbidities present at diagnosis, 5-year overall mortality rates for men with stage T1c disease ranged from 11.7% (95% CI, 10.2% to 13.1%) to 65.7% (95% CI, 55.9% to 70.1%), and prostate cancer-specific mortality rates ranged from 1.1% (95% CI, 0.0% to 2.7%) to 16.3% (95% CI, 13.8% to 19.4%). Ten-year overall mortality rates ranged from 28.8% (95% CI, 25.3% to 32.6%) to 94.3% (95% CI, 87.4% to 100%), and prostate cancer-specific mortality rates ranged from 2.0% (95% CI, 0.0% to 5.3%) to 27.5% (95% CI, 21.5% to 36.5%).
  
  
  CONCLUSIONS
  Patients and clinicians should consider using comorbidity-specific data to estimate the threat posed by newly diagnosed localized prostate cancer and the threat posed by competing medical hazards.
authors.affiliation: Department of Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06030, USA. albertsen@nso.uchc.edu
authors.forename: Peter C
authors.initials: PC
authors.lastname: Albertsen
authors.forename: Dirk F
authors.initials: DF
authors.lastname: Moore
authors.forename: Weichung
authors.initials: W
authors.lastname: Shih
authors.forename: Yong
authors.initials: Y
authors.lastname: Lin
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.forename: Grace L
authors.initials: GL
authors.lastname: Lu-Yao
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002454:Cell Differentiation; D015897:Comorbidity; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D014481:United States / Q000453:epidemiology