The old adage, prostate cancer is the cancer that you die with not the cancer you die from has been around for a long time. No question compared too many other cancers prostate cancer does progress more slowly than many other cancers. But, is this adage true?
Men with prostate cancer have competing mortality risks and it is assumed that a large proportion of these men will die of other causes.
D. J. Lewinshtein, C. R. Porter; Virginia Mason Medical Center, Seattle, WA sought to confirm this hypothesis by looking at a cohort of men with metastatic PC who had prior definitive treatment. He anaylisised 1,004 consecutive patients who had a radical prostatectomy at Virginia Mason Medical Center in Seattle, Washington. They performed a Kaplan Meier survival analysis and lifetables were used to analyze time to metastases (METS) and death. Univariate and multivariate Cox regression models addressed the prognostic significance of METS on death and PC-specific death.
They then searched Washington State death certificates were to assess cause of death of the men in the cohort.
They found that of the 1,004 patients, 99 (9.9%) had METS. The actuarial METS-free survival for all 1,004 men was 81% (95% confidence interval
Median time to METS after surgery was not reached for the entire cohort. Of all patients, METS were predictive of PC-specific death on univariate (HR = 27.3, p < 0.001) and multivariate (HR = 10.0, p < 0.001) Cox Regression. Of those with documented biochemical recurrence (BCR), median time from BCR to METS was 2.7 years (95% CI, 2.5-3.0).Of those with METS, median time from surgery to METS was 6.7 years (95% CI, 5.6-7.7), and mean time from METS to death was 5.0 years (95% CI, 4-5.9). Of those with METS, only pre-op PSA was predictive (HR = 1.1, p < 0.05) of PC-specific death on univariate Cox regression. On multivariate analysis, PSA was no longer significant (p = 0.05). However, PSA was predictive of overall death on multivariate analysis, but pathological Gleason was not. Of all patients with METS, 77 (77.7%) died. Of those, 71% were PC-specific, 10.4% cardiovascular, 5.2% pulmonary, 4% lung cancer, and 12% other.The researchers Concluded that the minority of patients will develop METS during their course with prostate cancer. The time from METS to death was 5 years, which is longer than previous studies. Thirty percent (30%) of those with METS died of other causes.The adage does stand up to scrutiny because they suggest that many men with advanced prostate cancer will have other serious medical issues that might impact on their overall survival. In other words, men with advanced prostate cancer need to carefully followed by other physicians in conjunction with their oncologist.Information presented at the 2010 Genitourinary Cancers Symposium Session Type and Session Title: General Poster Session A: Prostate Cancer Abstract No: 26Joel T Nowak, MA, MSW[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]