title: Comorbidity and age cannot explain variation in life expectancy associated with treatment of non-metastatic prostate cancer.
abstract: BACKGROUND
  Age and Charlson comorbidity index (CCI) affect life expectancy (LE) and other-cause mortality (OCM) in non-metastatic prostate cancer (nmPCa) patients. We examined their ability to predict OCM in individuals treated with radical prostatectomy (RP), brachytherapy (BT), external beam radiation (EBRT) androgen deprivation (ADT) or observation. We postulated that these variables are not sufficient to explain OCM and LE patterns according to different treatment types.
  
  
  METHODS
  We relied on the SEER-Medicare database from 1991 to 2009. Overall, 283,125 patients with non-metastatic prostate cancer aged ≥66 years were treated with RP (15.5%), BT (13.9%), EBRT (21.4%), ADT alone (16.3%) or observation (32.8%). Cumulative incidence of OCM and LE was stratified by treatment type and adjusted for age and CCI. Competing risks regression was also used.
  
  
  RESULTS
  OCM rates vary according to treatment, despite age and CCI adjustment. In RP or BT patients, LE exceeds 10 years, regardless of age and CCI. Conversely, a 10-year LE is not reached by patients >74 years treated with observation or ADT. In OCM competing risks regression, age, CCI and treatment type achieved independent predictor status (all p < 0.001).
  
  
  CONCLUSIONS
  In patients with nmPCa, neither age nor CCI can accurately estimate OCM or LE in excess of 10 years. Primary treatment assignment is a strong determinant of OCM and LE, where RP and BT patients enjoy better OCM and LE rates than observation ADT or EBRT patients. In consequence, better clinical tools are needed to accurately assess OCM and LE in those settings.
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada. katharina.boehm@unimedizin-mainz.de.|Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany. katharina.boehm@unimedizin-mainz.de.
authors: Katharina
authors: K
authors: Boehm
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Paolo
authors: P
authors: Dell'Oglio
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
authors: Zhe
authors: Z
authors: Tian
authors: Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Umberto
authors: U
authors: Capitanio
authors: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Felix K H
authors: FKH
authors: Chun
authors: Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Derya
authors: D
authors: Tilki
authors: Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
authors: Axel
authors: A
authors: Haferkamp
authors: Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors: Fred
authors: F
authors: Saad
authors: Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: Martini-Clinic, Prostate Cancer Centre, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Markus
authors: M
authors: Graefen
authors: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors: Pierre I
authors: PI
authors: Karakiewicz
mesh_terms: D000367:Age Factors; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D015897:Comorbidity; D006801:Humans; D008017:Life Expectancy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology; D011878:Radiotherapy / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D018931:Antineoplastic Agents, Hormonal
keywords: Competing risks analysis; Elderly patients; Life expectancy; Mortality; Prostate cancer; Radical prostatectomy