CAUSES OF DEATH IN PATIENTS WITH SCREEN-DETECTED PROSTATE CANCER

INTRODUCTION AND OBJECTIVE: Screening for prostate cancer (PCa) provides lead time in the detection of cancer. There are limited data on the risk of death from prostate cancer versus other causes in men with screen-detected PCa. We evaluated cause and timing of death in men with screen-detected PCa with different treatments. METHODS: We studied 981 deceased men were diagnosed with PCa in a screening study from 1989 to 2001. These men had selected their treatment and enrolled in a prospective follow-up study. The screening protocol has been published (Cancer 80:1852, 1997). We determined cause of death by 1) questioning a family member, 2) reviewing the death certificate, or 3) the National Death Index. We present the 10-year probability of death from PCa or other causes of men treated with surgery (RP), radiation (RT) , watchful waiting (WW), and hormonal therapy (HT). RESULTS: The 10-year probabilities of death from PCa and from other causes appear in table 1. The median time from diagnosis to PCa death was 71 months and 91 months for other causes. In men treated with RP or RT, there were fewer PCa deaths than in patients treated with WW or HT. Patients treated with RP had both fewer PCa deaths and fewer other-cause deaths than patients treated with RT, WW, or HT. Table 2 shows median ages at diagnosis and at death. CONCLUSIONS: In these men with screen-detected PCa, the probability of death from PCa was generally less than from other causes. Both death from PCa and other causes were lower in younger patients treated with RP than in patients receiving other treatments. The higher death rates from PCa with WW or HT suggest that definitive treatment is more effective in preventing PCa death than WW or HT. The higher death rates from other causes could lead to underestimation of the PCa death rates in men with longer life expectancy.