Age, Tumor Risk, and Comorbidity on Competing Risks for Survival in Men With Prostate Cancer

MedicalResearch.com eInterview with Timothy J. Daskivich, MD
Robert Wood Johnson Foundation Clinical Scholars®
University of California Los Angeles
Division of General Internal Medicine and Health Services Research
10940 Wilshire Blvd, 7th Floor Suite 710, Room 721
Los Angeles, California 90024

MedicalResearch.com: What are the main findings of the study?  Were any of the findings unexpected?

Dr. Daskivich:  We found that age and a simple count of comorbidities were strongly predictive of likelihood of dying of causes other than prostate cancer.  When we put numbers to it, it was surprising how often older men with multiple comorbidities were dying of something else than their prostate cancer within 14 years of diagnosis.  For example, a 75-year old man with 3 or more comorbidities—diabetes, high blood pressure, and history of heart attack—had a probability of death from something other than CaP of 71% at 10 years.  For a 71-year old man with 3 or more comorbidities, the probability was 60%.  We compared that to the amount of time they were dying of prostate cancer, which was 3% for low-risk disease and 7% for intermediate-risk disease.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Daskivich: Clinicians and patients should know that older and sicker men have a high likelihood of dying of something else and low likelihood of dying of prostate cancer, when the cancer is low- and intermediate-risk.   Such men may wish to consider choosing conservative over aggressive treatment in this setting, given the substantial morbidity associated with aggressive treatment.

However, men with high-risk cancers may wish to consider aggressive treatment regardless of age or comorbidity, given the high-risk of cancer mortality within 10 years for these aggressive tumors.

We hope that this information will help older and sicker men make better decisions about when to pursue aggressive treatment for early-stage prostate cancer.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Daskivich: We need to find better ways to communicate this sensitive but important information about survival to patients when they make treatment decisions.  Increased transparency and effective communication about likelihood of survival will help patients to make better treatment decisions and improve quality of life in their remaining years.

Citation:

Effect of Age, Tumor Risk, and Comorbidity on Competing Risks for Survival in a U.S. Population–Based Cohort of Men With Prostate Cancer

Daskivich TJ, Fan KH, Koyama T, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Stanford JL, Stroup AM, Litwin MS, Penson DF.

Ann Intern Med. 2013 May 21;158(10):709-17.
doi: 10.7326/0003-4819-158-10-201305210-00005

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