title: Predicting Life Expectancy in Men Diagnosed with Prostate Cancer.
abstract: BACKGROUND
  The widespread use of prostate-specific antigen (PSA) screening has led to the detection of more indolent prostate cancer (PCa) in healthy men. PCa treatment and screening must therefore balance the potential for life gained against the potential for harm. Fundamental to this balance is physician awareness of a patient's estimated life expectancy (LE).
  
  
  OBJECTIVE
  To review the evidence on LE differences between men diagnosed with PCa and the general population. To examine clinician- and model-predicted LE and publicly available LE calculators.
  
  
  METHODS
  A comprehensive search of the PubMed database between 1990 and September 2014 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Free text protocols of the following search terms were used "life expectancy prostate cancer", "life expectancy non-cancer", "non-cancer mortality prostate", and "comorbidity-adjusted life expectancy". Two internet search engines were queried daily for 1 mo for the search term "life expectancy calculator", and the top 20 results were examined.
  
  
  RESULTS
  Of 992 articles and 32 websites screened, 17 articles and nine websites were selected for inclusion. Men with non-screening-detected PCa and distant disease at diagnosis were found to have shorter LE than age-matched peers, whereas men with localized PCa had prolonged LE. In general, clinician-predicted 10-yr LE was pessimistic and of limited accuracy; however, model-predicted LE provided only modest improvements in accuracy (c-index of models 0.65-0.84). Online LE calculators provide consistent LE estimates, but government life tables provide LE estimates near the mean for all calculators examined.
  
  
  CONCLUSIONS
  The accuracy of clinician-predicted survival is limited, and while available statistical models offer improvement in discrimination, it is unclear whether they provide advantages over freely available government life tables.
  
  
  RESULTS
  We examined differences in life expectancy between men diagnosed with prostate cancer and the general population, and ways of predicting life expectancy to help guide treatment decisions. We found that current models for predicting life expectancy specific to prostate cancer might not be any better than government life tables or simple rules of thumb.
authors.affiliation: VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jsammon79@gmail.com.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: D'Amico
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Gettman
authors.affiliation: Department of Urology, University of Hamburg Eppendorf, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.affiliation: Department of Urology, Urological Research Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Urologic Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D002423:Cause of Death; D015897:Comorbidity; D003661:Decision Support Techniques; D006801:Humans; D008017:Life Expectancy; D008297:Male; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality*
keywords: Life expectancy; Prediction; Prostate cancer; Survival
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