title: Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study.
abstract: BACKGROUND
  Guidelines recommend against treating localized prostate cancer (PCa) in men with a greater than 10-year life expectancy. However, physicians have difficulty accurately estimating life expectancy.
  
  
  OBJECTIVE
  We used data from a population-based observational study to develop a nomogram to estimate long-term other-cause mortality based on self-reported health status (SRHS), race/ethnicity, and age at diagnosis.
  
  
  METHODS
  This was an observational study.
  
  
  METHODS
  Men diagnosed with localized PCa from October 1994 through October 1995 participated in the study.
  
  
  METHODS
  Initial measures obtained 6 months after diagnosis included sociodemographic and tumor characteristics, treatment, and a single item on the SRHS, with response options ranging from excellent to poor. We used Surveillance, Epidemiology, and End-Results program data to determine date and cause of death through December 2010. We estimated other-cause mortality with proportional hazards survival analyses, accounting for competing risks.
  
  
  RESULTS
  We evaluated 2,695 men, of whom 74% underwent aggressive therapy (surgery or radiotherapy). At the initial survey, 18% reported excellent (E), 36% very good (VG), 31% good (G), and 15% fair/poor (F/P) health. Healthier men were younger, and more likely to be white, better educated, and to undergo surgery. At follow-up, 44% of the cohort had died; 78% of deaths were from causes other than PCa. SRHS predicted other-cause mortality; for men reporting E, VG, G, F/P health, the cumulative incidences of other-cause mortality were 20%, 29%, 40%, and 53%, respectively, p < 0.001. Compared to a reference of excellent SRHS, multivariable hazard ratios (95% CI) for other-cause mortality for men reporting VG, G, and F/P health were 1.22 (0.97-1.54), 1.73 (1.38-2.17), and 2.71 (2.11-3.48), respectively.
  
  
  CONCLUSIONS
  Responses to a one-item SRHS measure were strongly associated with other-cause mortality 15 years after PCa diagnosis. Men reporting fair/poor health had substantial risks for other-cause mortality, suggesting limited benefit for undergoing aggressive treatment. SRHS can be considered in supporting informed decision-making about PCa treatment.
authors: University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA, rhoffman@unm.edu.
authors: Richard M
authors: RM
authors: Hoffman
authors: Tatsuki
authors: T
authors: Koyama
authors: Peter C
authors: PC
authors: Albertsen
authors: Michael J
authors: MJ
authors: Barry
authors: Timothy J
authors: TJ
authors: Daskivich
authors: Michael
authors: M
authors: Goodman
authors: Ann S
authors: AS
authors: Hamilton
authors: Janet L
authors: JL
authors: Stanford
authors: Antoinette M
authors: AM
authors: Stroup
authors: Arnold L
authors: AL
authors: Potosky
authors: David F
authors: DF
authors: Penson
mesh_terms: D000328:Adult; D000368:Aged; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D018426:SEER Program; D057566:Self Report; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen