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Causes of death in men with localized prostate cancer: a nationwide, population‐based study
Author(s) -
Van Hemelrijck Mieke,
Folkvaljon Yasin,
Adolfsson Jan,
Akre Olof,
Holmberg Lars,
Garmo Hans,
Stattin Pär
Publication year - 2016
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.13059
Subject(s) - medicine , prostate cancer , cause of death , comorbidity , population , cancer , disease , demography , proportional hazards model , environmental health , sociology
Objective To detail the distribution of causes of death from localized prostate cancer ( PC a). Patients and Methods The database PCB ase Sweden links the Swedish National Prostate Cancer Register with other nationwide population‐based healthcare registers. We selected all 57 187 men diagnosed with localized PC a between 1997 and 2009 and their 114 374 PC a‐free control subjects, matched according to age and county of residence. Mortality was calculated using competing risk regression analyses, taking into account PC a risk category, age and Charlson comorbidity index ( CCI ). Results In men with low‐risk PC a, all‐cause mortality was lower compared with that in corresponding PC a‐free men: 10‐year all‐cause mortality was 18% for men diagnosed at age 70 years, with a CCI score of 0, and 21% among corresponding control subjects. Of these cases, 31% died from cardiovascular disease ( CVD ) compared with 37% of the corresponding control subjects. For men with low‐risk PC a, 10‐year PC a‐mortality was 0.4, 1 and 3% when diagnosed at age 50, 60 and 70 years, respectively. PC a was the third most common cause of death (18%), after CVD (31%) and other cancers (30%). By contrast, PC a was the most common cause of death in men with intermediate‐ and high‐risk localized PC a. Conclusions Men with low‐risk PC a had lower all‐cause mortality than PC a‐free men because of lower CVD mortality, driven by early detection selection; however, for men with intermediate‐ or high‐risk disease, the rate of PC a death was substantial, irrespective of CCI score, and this was even more pronounced for those diagnosed at age 50 or 60 years.