Abstract
OBJECTIVE
To investigate the relationship between increasing life expectancy and nonprostate
cancer (competing) mortality after radical prostatectomy.
PATIENTS AND METHODS
We studied a single-center sample of 6809 consecutive patients who underwent radical
prostatectomy between 1992 and 2016 with a median age of 65 years and a median follow-up
of 7.9 years. Multivariate competing risk analyses were performed with competing mortality
as endpoint. Linear trends over the years of surgery for 5-year competing mortality
rates and for mean ages were calculated using linear regression analyses. We estimated
the number of live years gained over time using a heuristic model-based calculation:
(hazard ratio year of surgery) 24 calendar years × (hazard ratio age at surgery) gained life years = 1.
RESULTS
After controlling for age, nonprostate cancer mortality decreased significantly during
the observation period. Accumulated over the 24 years, this decrease of mortality
corresponded to the effect of 6.3 years of calendric age. Most of the decrease in
nonprostate cancer mortality (predominantly attributable to noncancer causes of death)
was seen in patients aged 65 years or older (8.1 years gained), whereas there was
only a marginal decrease in patients younger than 65 years (only 1 year gained). The
decrease in nonprostate cancer mortality was accompanied by a slight increase of mean
age at surgery (2.7 years) that did not nearly compensate the decreasing risk.
CONCLUSION
Clinicians should be aware of the decreasing competing mortality risk in elderly candidates
for radical prostatectomy in order to avoid undertreatment.
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References
- Structured population-based prostate-specific antigen screening for prostate cancer: The European Association of Urology position in 2019.Eur Urol. 2019; 76: 142-150
- Validation of the social security administration life tables (2004-2014) in localized prostate cancer patients within the Surveillance, Epidemiology, and End Results database.Eur Urol Focus. 2018; 5: 807-814
- Changing trends in surgical management of prostate cancer: the end of overtreatment?.Eur Urol. 2015; 68: 175-178
- Prospects for life span extension.Ann Rev Med. 2009; 60: 457-469
- Ageing populations: the challenges ahead.Lancet. 2009; 374: 1196-1208
Statistisches Bundesamt: Sterbefälle und Lebenserwartung. [Federal Department of Statistics: mortality and life expectancy]. Available at website:https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoelkerung/Sterbefaelle-Lebenserwartung/_inhalt.html. (Accessed April 2, 2020).
- Follow-up of prostatectomy versus observation for early prostate cancer.N Engl J Med. 2017; 377: 132-142
- Radical prostatectomy or watchful waiting in prostate cancer—29-Year follow-up.N Engl J Med. 2018; 379: 2319-2329
- A 16-yr follow-up of the European Randomized study of Screening for Prostate Cancer.Eur Urol. 2019; 76: 43-51
- Natural history of early, localized prostate cancer: a final report from three decades of follow-up.Eur Urol. 2013; 63: 428-435
United Nations, Population Division, Department of Economic and Social Affairs: World Population Prospects 2019. Mortality Data. Life expectation at birth, male. Available at website:https://population.un.org/wpp/Download/Standard/Mortality/. (Accessed April 2, 2020).
- Screening for colon cancer in older adults: risks, benefits, and when to stop.Mayo Clin Proc. 2020; 95: 184-196
- Perceived life expectancy and colorectal cancer screening intentions and behaviour: a population-based UK study.Prev Med Rep. 2019; 16101002
Article info
Publication history
Published online: April 22, 2020
Accepted:
April 8,
2020
Received:
December 18,
2019
Second revision, Ms. No. URL-D-19-02437Identification
Copyright
© 2020 Published by Elsevier Inc.
