Comorbid illnesses still more likely to kill prostate cancer survivors

Men die with prostate cancer, not of it, even when the disease recurs after treatment, researchers said.

According to this analysis, men with significant comorbidity have a 41% risk of death from other causes six years after treatment, several years before significant survival benefits of aggressive local treatment can be realized. Researchers suggested in a research letter in the August 9/23 Archives of Internal Medicine that men strongly consider conservative treatment for their clinically localized prostate cancer.

Researchers applied a prognostic utility, the Total Illness Burden Index for Prostate Cancer (TIBI-CaP). This is an 84-item questionnaire that measures both presence and severity of comorbid illness. Men with TIBI-CaP scores of 12 or greater were 13 times more likely to die of causes other than prostate cancer within 3.5 years of questionnaire administration, compared with men with the lowest scores.

Researchers sent the TIBI-CaP questionnaire to 4,635 active participants of the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national, observational prostate cancer registry. Of the 3,389 respondents, 2,900 completed it and were included in the study. The mean time from treatment to TIBI-CaP questionnaire completion was 41.4 months. The primary outcome was death from causes other than prostate cancer.

After a median follow-up of 6.2 years, overall mortality was 14.5% (n=420), while prostate cancer-specific mortality was only 3% (n=86). Among patients with TIBI-CaP scores at least 12, 41% died of other causes, compared with 6% of those with scores of 0 to 2 (P<0.001). Men with the highest TIBI-CaP scores were 10 times more likely to die of causes other than prostate cancer, compared with men with the lowest scores (hazard ratio, 10.3; 95% CI, 5.4 to 19.5)