Death from Other Causes Among Men with Early-stage Prostate Cancer

Among men with early-stage prostate cancer, assessment of other health problems may help guide prostate cancer treatment decisions; men who are likely to die of causes other than prostate cancer may not benefit from aggressive prostate cancer treatment. These findings were published in the Archives of Internal Medicine.

Men with early-stage prostate cancer have the option of being treated aggressively, which may include radiation therapy and surgery, or conservatively, which may involve no therapy until symptoms appear (watchful waiting or active surveillance). The choice of treatment can be difficult; for men with low-risk prostate, cancer there is no clear proof that early treatment prolongs survival compared with treatment that is deferred until there is evidence of disease progression.

Some patients who have other medical conditions (comorbidities) in addition to prostate cancer may not live long enough to benefit from prostate cancer treatment. Accurate assessment of comorbidities among patients with early-stage prostate cancer could help doctors and patients make treatment decisions.

The Total Illness Burden Index for Prostate Cancer (TIBI-CaP) is a questionnaire that assesses comorbidities among patients with prostate cancer. Among the advantages of TIBI-CaP is efficiency—the questionnaire takes only 15 minutes to complete. Higher TIBI-CaP scores indicate greater presence and severity of illnesses in addition to prostate cancer.

In a previous evaluation of TIBI-CaP, men with the highest scores (12 or higher) were 13 times more likely to die of causes other than prostate cancer within 3.5 years of completing the questionnaire compared with men with lower scores. To further evaluate the association between TIBI-CaP scores and death from other causes, researchers recently conducted a follow-up of study participants.

  • At a median of six years after receiving treatment for early-stage prostate cancer, 15% of study participants had died. The majority of deaths were from causes other than prostate cancer; only 3% had died from prostate cancer.
  • 41% of patients with the highest TIBI-CaP scores (12 or higher) died of causes other than prostate cancer compared with 6% of those with the lowest scores.

According to the researchers, higher TIBI-CaP scores were “significantly associated” with greater risk of death from causes other than prostate cancer, as men with the highest scores were 10 times more likely to die of other causes compared with men with the lowest scores. As to how these findings may affect treatment decisions, the researchers stated: “Because men with significant comorbidity have a high likelihood of short- to intermediate-term mortality, they may wish to strongly consider conservative over aggressive treatment for their clinically localized prostate cancer.”

Reference: Daskivich T, Sadetsky N, Sherrie H. Kaplan SH,et al. Severity of comorbidity and non–prostate cancer mortality in men with early-stage prostate cancer [Research Letter]. Archives of Internal Medicine. VOL 170 (NO. 15), AUG 9/23, 2010.

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