title: Which better predicts mortality among older men, a prostate cancer (PCa) diagnosis or vulnerability on the Vulnerable Elders Survey (VES-13)? A retrospective cohort study.
abstract: Older men with a prostate cancer (PCa) diagnosis face competing mortality risks. Little is known about the prevalence of vulnerability and predictors of mortality in this population compared to men without a PCa diagnosis. We examined the predictive utility of the Vulnerable Elders Survey (VES-13) for mortality in older men with a PCa diagnosis as compared to controls.
  
  
  
  Men aged ≥65years from an urban geriatrics clinic completed the VES-13 between 2003 and 2008. Each patient with a PCa diagnosis was matched by age to five controls, resulting in 59 patients with a PCa diagnosis and 318 controls. Cox proportional hazard models were used to determine the association of a PCa diagnosis and vulnerability on the VES-13 with mortality.
  
  
  
  The mean age for men with a PCa diagnosis and controls was 77.9years and 76.1years, respectively. Of those with a PCa diagnosis, 74.6% had no active disease or a rising PSA only. Regardless of PCa diagnosis, vulnerable individuals on the VES-13 were more likely to die during the study period (VES-13≥3: HR=4.46, p<0.01; VES13≥6: HR=3.77, p<0.01). Men with a PCa diagnosis were not more likely to die compared to age-matched controls (VES-13≥3: HR=1.14, p=0.59; VES13≥6: HR=1.06, p=0.83). Vulnerability for men with a PCa diagnosis was more predictive of mortality. Therefore, the assessment of vulnerability is important for establishing goals of care.
authors.affiliation: James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA. Electronic address: lmlowenstein@mdanderson.org.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Lowenstein
authors.affiliation: James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.affiliation: Division of Geriatrics and Aging, University of Rochester, 435 East Henrietta Road, Rochester, NY 14620, USA.
authors.forename: Heather Hopkins
authors.initials: HH
authors.lastname: Gil
authors.affiliation: Department of Public Health Sciences, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, USA.
authors.forename: Chintan
authors.initials: C
authors.lastname: Pandya
authors.affiliation: Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, 5841 South Maryland Ave., MC, 6098, Chicago, IL, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Hemmerich
authors.affiliation: Division of Geriatric Medicine, St. Louis University School of Medicine, 1402 S. Grand Blvd., St. Louis, MO. 63104, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rodin
authors.affiliation: Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, 5841 South Maryland Ave., MC, 6098, Chicago, IL, USA.
authors.forename: William
authors.initials: W
authors.lastname: Dale
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D016330:Frail Elderly / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011471:Prostatic Neoplasms / Q000401:mortality*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
keywords: Mortality; Prostate cancer; Vulnerability