title: Successful external validation of a model to predict other cause mortality in localized prostate cancer.
abstract: BACKGROUND
  Although life expectancy estimation is vital to decision making for localized prostate cancer, there are few, if any, valid and usable tools. Our goal was to create and validate a prediction model for other cause mortality in localized prostate cancer patients that could aid clinician's initial treatment decisions at the point of care.
  
  
  METHODS
  We combined an adjusted Social Security Administration table with a subset of comorbidities from a UK actuarial life expectancy model. Life tables were adjusted on the basis of survival data from a cohort of almost 10,000 radical prostatectomy patients treated at four major US academic institutions. Comorbidity-specific odds ratios were calculated and incorporated with baseline risk of mortality. We externally validated the model on 2898 patients from the Prostate Cancer Outcomes Study, which included men diagnosed with prostate cancer in six SEER cancer registries. These men had sufficient follow-up for our endpoints of 10- and 15-year mortality and also had self-reported comorbidity data.
  
  
  RESULTS
  Life expectancy for prostate cancer patients were close to that of a typical US man who was 3 years younger. On external validation, 10- and 15-year concordance indexes were 0.724 and 0.726, respectively. Our model exhibited excellent calibration. Taking into account differences between how comorbidities are used in the model versus how they were recorded in the validation cohort, calibration would improve for most patients, but there would be overestimation of the risk of death in the oldest and sickest patients.
  
  
  CONCLUSIONS
  We successfully created and externally validated a new life expectancy prediction model that, while imperfect, has clear advantages to any alternative. We urge consideration of its use in counseling patients with localized prostate cancer.
authors: Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
authors: Matthew
authors: M
authors: Kent
authors: Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA.|Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
authors: David F
authors: DF
authors: Penson
authors: Division of Urology, University of Connecticut Health Center, Farmington, CT, USA.
authors: Peter C
authors: PC
authors: Albertsen
authors: Department of Epidemiology, Emory University, Atlanta, GA, USA.
authors: Michael
authors: M
authors: Goodman
authors: Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors: Ann S
authors: AS
authors: Hamilton
authors: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors: Janet L
authors: JL
authors: Stanford
authors: New Jersey State Cancer Registry, Trenton, NJ, USA.
authors: Antoinette M
authors: AM
authors: Stroup
authors: Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.|Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Behfar
authors: B
authors: Ehdaie
authors: Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
authors: Peter T
authors: PT
authors: Scardino
authors: Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA. vickersa@mskcc.org.
authors: Andrew J
authors: AJ
authors: Vickers
mesh_terms: D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D003661:Decision Support Techniques; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D014481:United States