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The impact of co-morbidity on life expectancy among men with newly diagnosed prostate cancer
Peter C. Albertsen, MD1, Dirk F. Moore, PhD2, Weichung Shih, PhD2, Yong Lin, PhD2, Hui Li, PhD3, Grace Lu-Yao, PhD4.
1University of Connecticut, Farmington, CT, USA, 2University of Medicine and Dentistry, Piscataway, NJ, USA, 3Cancer Institute of New Jersey, New Brunswick, NJ, USA, 4Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

BACKGROUND:
Because prostate cancer frequently has a long natural history, many professional organizations suggest that screening and treatment should be limited to men with a life expectancy greater than 10 years.
METHODS:
To provide patients and clinicians more accurate contemporary estimates of co-morbidity adjusted life expectancy stratified by patient age, tumor stage and tumor grade, we assembled a large population-based cohort of 14516 men with localized T1 or T2 prostate cancer who were managed conservatively following diagnosis.
RESULTS:
At the end of the study period, most men were either alive or dead of causes other than prostate cancer. Only 48% of men with 2 or more co-morbidities were still alive compared with 71% and 61% of men with 0 and 1 co-morbidity respectively. Men with moderately and poorly differentiated disease were more likely to die from causes other than prostate cancer although prostate cancer mortality was higher among men with poorly differentiated disease.
For men with 0, 1 or 2 or more co-morbidities, the ten year prostate cancer-specific mortality was 1-4% for men with moderately differentiated, T1c disease and 2-8% for men with poorly differentiated disease. The ten year competing risk mortality differed according to co-morbidity. For men moderately differentiated T1c disease with 0, 1 or 2 or more co-morbidities the competing risk mortality was 5-23%, 11-34% and 25-40% respectively. For men with poorly differentiated T1c disease with 0, 1, or 2 or more co-morbidities, the ten year competing risk mortality was 5-23%, 4-19% and 17-27% for men with poorly differentiated disease.
CONCLUSIONS:
The probability of dying from prostate cancer within ten years of diagnosis of screen detected disease in the absence of treatment is minimal for men over age 65 at diagnosis. The probability of dying from competing risks during this same period ranges from 5-40% depending upon a patient’s age and the number of co-morbidities at diagnosis.


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