title: Effect of age, tumor risk, and comorbidity on competing risks for survival in a U.S. population-based cohort of men with prostate cancer.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To determine the effect of age, comorbidity, and tumor risk on other-cause and prostate cancer-specific mortality in men with early-stage disease.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A nationally representative, population-based cohort.
  
  
  METHODS
  3183 men with nonmetastatic prostate cancer at diagnosis.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Comorbid conditions were self-reported.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  National Cancer Institute.
authors.affiliation: University of California, Los Angeles, Los Angeles, CA 90024, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.forename: Kang-Hsien
authors.initials: KH
authors.lastname: Fan
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Koyama
authors.forename: Peter C
authors.initials: PC
authors.lastname: Albertsen
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Janet L
authors.initials: JL
authors.lastname: Stanford
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology; D012307:Risk Factors