- Email: [email protected]
341 PROSTATE CANCER SURVIVORSHIP: COMPETING CAUSES OF DEATH BY REVIEW OF 3642 MEN AFTER PROSTATECTOMY
Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
METHODS: We identified 7883 men who underwent RP in the early prostate-specific antigen (PSA) era (1987–1997). Of these 4812 (61%) with cT2 and 843 (15%) with cT3 disease were analyzed for progression free, cancer specific, and overall survival by Kaplan-Meier plots. RESULTS: The median follow-up was 14.3 years (0.1–23.5). Clinical over-staging of cT3 disease occurred in 26% (223/843) with subsequent down-staging to pT2 at RP. Men with cT3 were more likely than men with cT2 disease to have adverse features including patho´ 7 (59% vs 39%, p⬍0.0001), aneuploid tumor logic Gleason score °Y (14% vs 6%, p⬍0.0001), lymph node metastasis (27% vs 7%, p⬍0.0001), positive surgical margin (56% vs 38%, p⬍0.0001), larger tumor volumes (5.2 vs 2.6 cm3, p⬍0.0001) and require post-operative hormonal or radiotherapy (42% vs 76%, p⬍0.0001). Men with cT3 were twice as likely to have disease progression (32% vs 16%) and die of prostate cancer (15% vs 6%) than men with cT2 disease. Cancer specific survival at 20 years follow-up (90% vs 80%, p⬍0.0001) was higher for cT2 than cT3 disease (figure 1). CONCLUSIONS: cT3 prostate cancer is overstaged in the PSA era, however cT3 stills predicts adverse pathologic features at RP. While inferior to those of men with cT2 disease, oncologic outcomes for men with cT3 disease remain high with long term follow-up. RP as part of a multimodal treatment strategy for patients with cT3 disease offers durable cancer control and survival rates 20 years following RP.
THE JOURNAL OF UROLOGY姞
e137
RESULTS: Overall, 284 (11.7%) patients with BCR experienced SP and 556 (22.9%) died, with 140 (5.8%) dying from prostate cancer. A total of 399 (16.4%) men underwent salvage radiation (RT) and 209 (8.6%) received androgen deprivation therapy (ADT) at BCR and before SP. Ten-year SP-free and cancer-specific survival for patients after BCR was 84% and 91%. The median time from RP to BCR was 3.1 years (IQR 1.2, 5.9). Cancer-specific mortality 10 years after BCR was 9.9%, 9.3%, 7.8%, and 4.7% for patients who experienced BCR ⬍1.2 years, 1.2–3.1 years, 3.1–5.9 years, and ⬎ 5.9 years after RP, respectively (p⫽0.10). On multivariate analysis (Table), time from RP to BCR was not significantly associated with the risk of SP (p⫽0.15) or cancer-specific mortality (p⫽0.29). Older patient age, increased pathologic Gleason score, advanced tumor stage, and rapid PSA velocity did predict SP and death from prostate cancer. CONCLUSIONS: Although only a minority of men experience SP and death from prostate cancer following BCR, an increased interval from RP to BCR is not independently associated with diminished risks of progression or mortality. Regardless of the timing of BCR, then, the decision to institute secondary therapies must balance the risk of disease progression based on clinical parameters with the cost and potential morbidity of treatment. Multivariate Analysis for Predictors of Systemic Progression (left) and Death from Prostate Cancer (right) Following BCR. Variable HR 95% CI p Value HR 95% CI p Value Patient age 1.02 1.00, 1.05 0.04 1.06 1.02, 1.10 0.001 Year of RP
0.95 0.91, 1.00
Pathological Gleason score
0.05
1.40 1.20, 1.60
Pathological tumor stage
1.20 1.03, 1.40
0.02
Time interval from RP to BCR
0.95 0.89, 1.02
0.15
0.99 0.91, 1.07
0.77
1.53 1.27, 1.86 ⬍ 0.0001 1.33 1.07, 1.66
0.01
0.94 0.83, 1.06
0.29
1.37 1.25, 1.49 ⬍ 0.0001
Log-linear PSA velocity 1.32 1.23, 1.40 Receipt of salvage RT
0.91 0.60, 1.40
0.68
0.87 0.47, 1.63
0.67
Receipt of salvage ADT
0.62 0.33, 1.18
0.15
0.98 0.45, 2.12
0.95
Source of Funding: None
341 Source of Funding: None
PROSTATE CANCER SURVIVORSHIP: COMPETING CAUSES OF DEATH BY REVIEW OF 3642 MEN AFTER PROSTATECTOMY Kenneth Nepple*, Adam Kibel, Seth Strope, Robert Grubb, Jennifer Haslag-Minoff, Kathleen Wolin, St. Louis, MO
340 LONG-TERM RISK OF CLINICAL PROGRESSION AFTER BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PROSTATECTOMY: THE IMPACT OF TIME TO RECURRENCE Stephen Boorjian*, R. Houston Thompson, Matthew Tollefson, Laureano Rangel, Eric Bergstralh, R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: The natural history of biochemical recurrence (BCR) after radical prostatectomy (RP) is variable, and does not always translate into systemic progression (SP) or prostate cancer death. We evaluated long-term clinical outcomes of patients with BCR, and determined predictors of disease progression and mortality in these men. METHODS: We reviewed our institutional registry of 14,632 patients who underwent RP between 1990 –2006 to identify 2,427 men with BCR (PSA ⱖ 0.4 ng/ml) who did not receive neoadjuvant or adjuvant therapy. Median follow-up was 11.5 years (interquartile range (IQR) 7.8, 14.7) after RP and 6.6 years (IQR 3.3, 10.1) after BCR. Patients were grouped into quartiles according to the time from RP to BCR. Survival after BCR was estimated using the Kaplan-Meier method and compared using the log rank test. Cox proportional hazard regression models were used to analyze clinicopathologic variables associated with SP and death from prostate cancer.
INTRODUCTION AND OBJECTIVES: In patients who undergo surgery for prostate cancer, subsequent medical care may focus on prostate cancer recurrence. Research in cancer survivorship has suggested that general medical care and screening efforts may decrease after a cancer diagnosis, which is particularly important after radical prostatectomy (RP) because of the long life expectancy after treatment. We examined cause-specific mortality after RP to guide survivorship care in prostate cancer. METHODS: A cohort of 3642 men underwent RP at Washington University from 1995 to 2005. As part of a hospital-based tumor registry, pretreatment medical comorbidity was assessed by ACE-27, a validated instrument, into none, mild, and moderate/severe comorbidity. Information on survival and cause of death was obtained through review of the medical record and the Social Security Death Index. Five-year mortality was calculated by Kaplan-Meier method in risk groups (medical comorbidity by D’Amico risk category). Age-adjusted overall survival was calculated relative to the lowest risk group (no medical comorbidity, low risk prostate cancer) by Cox regression modeling. RESULTS: At a median follow-up of 72.1 months after RP, 271 of 3642 (7.4%) men had died. The table displays 5-year mortality categorized by risk groups. Age-adjusted overall mortality was increased in patients with high-risk prostate cancer or moderate/severe medical comorbidity compared to the lowest risk group, while the group
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Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
with both was inadequately powered for evaluation. Other cause mortality was 5.0 times more common than prostate cancer death (226 versus 45 men, respectively). Other-cause mortality included secondary cancers (94), cardiovascular (48), respiratory (14), and all other causes (70). Of men with no pretreatment medical comorbidity who died, cause of death was more likely to be of secondary cancer (n⫽48) than prostate cancer (n⫽27) or cardiovascular (n⫽19) cause. CONCLUSIONS: High risk prostate cancer or moderate/severe comorbidity drive overall survival after RP. Mortality from other cancers is proportionally more prevalent than would be expected. In addition to routine medical care, further studies of survivorship after RP should also focus on screening for other cancers. Table 1: Mortality five years after prostatectomy by comorbidity and D’Amico prostate cancer risk groups Comorbidity None (n ⫽ 2157) Mild (n ⫽ 1213) Mod/Severe (n ⫽ 272) LOW RISK PROSTATE CANCER Patients Died of prostate cancer, % (95%CI) Died of other cause, % (95%CI) Died of any cause, % (95%CI) Age-adjusted Overall Mortality Hazard Ratio (95%CI)
1512
794
156
0.2 (0.1–0.7)
0.3 (0.1–1.2)
0
1.9 (1.3–2.9)
4.0 (2.7–5.8)
7.4 (4.0–13.3)
2.2 (1.5–3.1)
4.3 (2.9–6.1)
7.4 (4.0–13.3)
1 (Reference) 1.21 (0.92–1.60)
1.62 (1.01–2.58)
INTERMEDIATE RISK PROSTATE CANCER Patients Died of prostate cancer, % (95%CI) Died of other cause, %(95%CI) Died of any cause, % (95%CI) Age-adjusted Overall Mortality Hazard Ratio (95%CI)
513
330
85
Died of prostate cancer, % (95%CI) Died of other cause, % (95%CI) Died of any cause, % (95%CI) Age-adjusted Overall Mortality Hazard Ratio (95%CI)
CAUSE OF DEATH AFTER RADICAL PROSTATECTOMY IN A LARGE TERTIARY CENTER John Eifler*, Elizabeth Humphreys, Alan Partin, Misop Han, Baltimore, MD INTRODUCTION AND OBJECTIVES: A population-based study has demonstrated that the majority of men undergoing prostatectomy do not die of prostate cancer. We evaluated the cause of death in a large series of patients who underwent radical prostatectomy (RP). METHODS: The study population consisted of 18,829 patients who underwent RP at our institution between 1975 and 2010. Each patient was evaluated using a national database to identify which patients have died and classify the cause of death. These data were compared with general U.S. population data. RESULTS: A total of 1189 patients died (6.3%), including 379 men (2.0%) who died of prostate cancer. Patients were followed for a mean of 9.0 years (SD 5.7). The median age at the time of RRP was 59.0 years (range 33 – 81 years) and the median age at death was 71.0 years. Overall, 32% of all patients who underwent surgery died of prostate cancer, 30% died of a different malignancy, 18% died of cardiovascular disease, and an additional 20% died of other causes. Of 810 non-prostate cancer deaths, 44.0% were due to a separate malignancy, compared to 23% of deaths in the general U.S. population (including prostate cancer deaths). In our RP population, lung cancer was the most common cancer death (23.6%) other than prostate cancer, followed by pancreatic cancer (11.0%) and lymphoma (9.6%). These rates were compared to the general U.S. population (Table 2). CONCLUSIONS: Men who undergo RP are likely to die of non-prostate cancer causes. Nearly half of patients who survive their prostate cancer will die of a different malignancy. Non-Prostate Cancer Cause of Death N Post-RRP Pts (%) US Population 2007 (%) 32 4.0% 5.3%
Category Accident Alzheimer’s
20
2.5%
3.0%
1
0.1%
0.8%
36
4.4%
5.6%
4
0.5%
1.2%
Chronic respiratory
18
2.2%
5.4%
Diabetes
10
1.2%
3.0%
181
22.4%
25.1%
Assault 0.9 (0.3–2.5)
0.9 (0.2–3.5)
2.6 (0.7–10.2)
Cerebrovascular Chronic liver
2.7 (1.5–4.7)
3.6 (2.2–5.8)
3.9 (2.1–7.2)
4.7 (2.7–8.2)
17.9 (10.5–29.5)
20.1 (12.3–31.7)
Diseases of the heart Hypertension Malignant neoplasm Nephritis
1.04 (0.75–1.44) 0.91 (0.59–1.41)
3.95 (2.50–6.24)
HIGH RISK PROSTATE CANCER Patients
342
132
89
31
Other
3.6 (1.2–10.8)
10.0 (5.6–17.4)
6.0 (2.3–15.2)
9.4 (4.6–18.8)
2.14 (1.38–3.31) 2.11 (1.23–3.62)
Source of Funding: None
9.4 (4.6–18.8)
2.11 (1.23–3.62)
7
0.9%
1.9%
99
12.2%
18.5%
13
1.6%
0.8%
11
1.4%
2.1%
Sepsis
6
0.7%
1.4%
Suicide
10
1.2%
1.5%
810
100.0%
100.0%
5.3 (0.8–31.9)
8.2 (2.1–28.9)
1.0% 23.5%
Pneumonia
Category 4.5 (1.9–10.6)
0.7% 44.0%
Parkinsons Disease
Total 5.7 (2.6–12.3)
6 356
Lung
Cancer Death (Excluding Prostate Cancer) N RRP patients (%) US Pop. 2007 (%) 84 23.6% 37.0%
Pancreas
39
11.0%
5.9%
Colon
31
8.7%
9.1%
Lymphoma
34
9.6%
3.5%
Leukemia
16
4.5%
3.5%
Bladder
11
3.1%
2.5%
Liver and Biliary
18
5.1%
3.3%
Kidney/Renal Pelvis
14
3.9%
2.8%
Other
101
28.0%
28.0%
Total
356
100.0%
100.0%
METHODS: We identified 7883 men who underwent RP in the early prostate-specific antigen (PSA) era (1987–1997). Of these 4812 (61%) with cT2 and 843 (15%) with cT3 disease were analyzed for progression free, cancer specific, and overall survival by Kaplan-Meier plots. RESULTS: The median follow-up was 14.3 years (0.1–23.5). Clinical over-staging of cT3 disease occurred in 26% (223/843) with subsequent down-staging to pT2 at RP. Men with cT3 were more likely than men with cT2 disease to have adverse features including patho´ 7 (59% vs 39%, p⬍0.0001), aneuploid tumor logic Gleason score °Y (14% vs 6%, p⬍0.0001), lymph node metastasis (27% vs 7%, p⬍0.0001), positive surgical margin (56% vs 38%, p⬍0.0001), larger tumor volumes (5.2 vs 2.6 cm3, p⬍0.0001) and require post-operative hormonal or radiotherapy (42% vs 76%, p⬍0.0001). Men with cT3 were twice as likely to have disease progression (32% vs 16%) and die of prostate cancer (15% vs 6%) than men with cT2 disease. Cancer specific survival at 20 years follow-up (90% vs 80%, p⬍0.0001) was higher for cT2 than cT3 disease (figure 1). CONCLUSIONS: cT3 prostate cancer is overstaged in the PSA era, however cT3 stills predicts adverse pathologic features at RP. While inferior to those of men with cT2 disease, oncologic outcomes for men with cT3 disease remain high with long term follow-up. RP as part of a multimodal treatment strategy for patients with cT3 disease offers durable cancer control and survival rates 20 years following RP.
THE JOURNAL OF UROLOGY姞
e137
RESULTS: Overall, 284 (11.7%) patients with BCR experienced SP and 556 (22.9%) died, with 140 (5.8%) dying from prostate cancer. A total of 399 (16.4%) men underwent salvage radiation (RT) and 209 (8.6%) received androgen deprivation therapy (ADT) at BCR and before SP. Ten-year SP-free and cancer-specific survival for patients after BCR was 84% and 91%. The median time from RP to BCR was 3.1 years (IQR 1.2, 5.9). Cancer-specific mortality 10 years after BCR was 9.9%, 9.3%, 7.8%, and 4.7% for patients who experienced BCR ⬍1.2 years, 1.2–3.1 years, 3.1–5.9 years, and ⬎ 5.9 years after RP, respectively (p⫽0.10). On multivariate analysis (Table), time from RP to BCR was not significantly associated with the risk of SP (p⫽0.15) or cancer-specific mortality (p⫽0.29). Older patient age, increased pathologic Gleason score, advanced tumor stage, and rapid PSA velocity did predict SP and death from prostate cancer. CONCLUSIONS: Although only a minority of men experience SP and death from prostate cancer following BCR, an increased interval from RP to BCR is not independently associated with diminished risks of progression or mortality. Regardless of the timing of BCR, then, the decision to institute secondary therapies must balance the risk of disease progression based on clinical parameters with the cost and potential morbidity of treatment. Multivariate Analysis for Predictors of Systemic Progression (left) and Death from Prostate Cancer (right) Following BCR. Variable HR 95% CI p Value HR 95% CI p Value Patient age 1.02 1.00, 1.05 0.04 1.06 1.02, 1.10 0.001 Year of RP
0.95 0.91, 1.00
Pathological Gleason score
0.05
1.40 1.20, 1.60
Pathological tumor stage
1.20 1.03, 1.40
0.02
Time interval from RP to BCR
0.95 0.89, 1.02
0.15
0.99 0.91, 1.07
0.77
1.53 1.27, 1.86 ⬍ 0.0001 1.33 1.07, 1.66
0.01
0.94 0.83, 1.06
0.29
1.37 1.25, 1.49 ⬍ 0.0001
Log-linear PSA velocity 1.32 1.23, 1.40 Receipt of salvage RT
0.91 0.60, 1.40
0.68
0.87 0.47, 1.63
0.67
Receipt of salvage ADT
0.62 0.33, 1.18
0.15
0.98 0.45, 2.12
0.95
Source of Funding: None
341 Source of Funding: None
PROSTATE CANCER SURVIVORSHIP: COMPETING CAUSES OF DEATH BY REVIEW OF 3642 MEN AFTER PROSTATECTOMY Kenneth Nepple*, Adam Kibel, Seth Strope, Robert Grubb, Jennifer Haslag-Minoff, Kathleen Wolin, St. Louis, MO
340 LONG-TERM RISK OF CLINICAL PROGRESSION AFTER BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PROSTATECTOMY: THE IMPACT OF TIME TO RECURRENCE Stephen Boorjian*, R. Houston Thompson, Matthew Tollefson, Laureano Rangel, Eric Bergstralh, R. Jeffrey Karnes, Rochester, MN INTRODUCTION AND OBJECTIVES: The natural history of biochemical recurrence (BCR) after radical prostatectomy (RP) is variable, and does not always translate into systemic progression (SP) or prostate cancer death. We evaluated long-term clinical outcomes of patients with BCR, and determined predictors of disease progression and mortality in these men. METHODS: We reviewed our institutional registry of 14,632 patients who underwent RP between 1990 –2006 to identify 2,427 men with BCR (PSA ⱖ 0.4 ng/ml) who did not receive neoadjuvant or adjuvant therapy. Median follow-up was 11.5 years (interquartile range (IQR) 7.8, 14.7) after RP and 6.6 years (IQR 3.3, 10.1) after BCR. Patients were grouped into quartiles according to the time from RP to BCR. Survival after BCR was estimated using the Kaplan-Meier method and compared using the log rank test. Cox proportional hazard regression models were used to analyze clinicopathologic variables associated with SP and death from prostate cancer.
INTRODUCTION AND OBJECTIVES: In patients who undergo surgery for prostate cancer, subsequent medical care may focus on prostate cancer recurrence. Research in cancer survivorship has suggested that general medical care and screening efforts may decrease after a cancer diagnosis, which is particularly important after radical prostatectomy (RP) because of the long life expectancy after treatment. We examined cause-specific mortality after RP to guide survivorship care in prostate cancer. METHODS: A cohort of 3642 men underwent RP at Washington University from 1995 to 2005. As part of a hospital-based tumor registry, pretreatment medical comorbidity was assessed by ACE-27, a validated instrument, into none, mild, and moderate/severe comorbidity. Information on survival and cause of death was obtained through review of the medical record and the Social Security Death Index. Five-year mortality was calculated by Kaplan-Meier method in risk groups (medical comorbidity by D’Amico risk category). Age-adjusted overall survival was calculated relative to the lowest risk group (no medical comorbidity, low risk prostate cancer) by Cox regression modeling. RESULTS: At a median follow-up of 72.1 months after RP, 271 of 3642 (7.4%) men had died. The table displays 5-year mortality categorized by risk groups. Age-adjusted overall mortality was increased in patients with high-risk prostate cancer or moderate/severe medical comorbidity compared to the lowest risk group, while the group
e138
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
with both was inadequately powered for evaluation. Other cause mortality was 5.0 times more common than prostate cancer death (226 versus 45 men, respectively). Other-cause mortality included secondary cancers (94), cardiovascular (48), respiratory (14), and all other causes (70). Of men with no pretreatment medical comorbidity who died, cause of death was more likely to be of secondary cancer (n⫽48) than prostate cancer (n⫽27) or cardiovascular (n⫽19) cause. CONCLUSIONS: High risk prostate cancer or moderate/severe comorbidity drive overall survival after RP. Mortality from other cancers is proportionally more prevalent than would be expected. In addition to routine medical care, further studies of survivorship after RP should also focus on screening for other cancers. Table 1: Mortality five years after prostatectomy by comorbidity and D’Amico prostate cancer risk groups Comorbidity None (n ⫽ 2157) Mild (n ⫽ 1213) Mod/Severe (n ⫽ 272) LOW RISK PROSTATE CANCER Patients Died of prostate cancer, % (95%CI) Died of other cause, % (95%CI) Died of any cause, % (95%CI) Age-adjusted Overall Mortality Hazard Ratio (95%CI)
1512
794
156
0.2 (0.1–0.7)
0.3 (0.1–1.2)
0
1.9 (1.3–2.9)
4.0 (2.7–5.8)
7.4 (4.0–13.3)
2.2 (1.5–3.1)
4.3 (2.9–6.1)
7.4 (4.0–13.3)
1 (Reference) 1.21 (0.92–1.60)
1.62 (1.01–2.58)
INTERMEDIATE RISK PROSTATE CANCER Patients Died of prostate cancer, % (95%CI) Died of other cause, %(95%CI) Died of any cause, % (95%CI) Age-adjusted Overall Mortality Hazard Ratio (95%CI)
513
330
85
Died of prostate cancer, % (95%CI) Died of other cause, % (95%CI) Died of any cause, % (95%CI) Age-adjusted Overall Mortality Hazard Ratio (95%CI)
CAUSE OF DEATH AFTER RADICAL PROSTATECTOMY IN A LARGE TERTIARY CENTER John Eifler*, Elizabeth Humphreys, Alan Partin, Misop Han, Baltimore, MD INTRODUCTION AND OBJECTIVES: A population-based study has demonstrated that the majority of men undergoing prostatectomy do not die of prostate cancer. We evaluated the cause of death in a large series of patients who underwent radical prostatectomy (RP). METHODS: The study population consisted of 18,829 patients who underwent RP at our institution between 1975 and 2010. Each patient was evaluated using a national database to identify which patients have died and classify the cause of death. These data were compared with general U.S. population data. RESULTS: A total of 1189 patients died (6.3%), including 379 men (2.0%) who died of prostate cancer. Patients were followed for a mean of 9.0 years (SD 5.7). The median age at the time of RRP was 59.0 years (range 33 – 81 years) and the median age at death was 71.0 years. Overall, 32% of all patients who underwent surgery died of prostate cancer, 30% died of a different malignancy, 18% died of cardiovascular disease, and an additional 20% died of other causes. Of 810 non-prostate cancer deaths, 44.0% were due to a separate malignancy, compared to 23% of deaths in the general U.S. population (including prostate cancer deaths). In our RP population, lung cancer was the most common cancer death (23.6%) other than prostate cancer, followed by pancreatic cancer (11.0%) and lymphoma (9.6%). These rates were compared to the general U.S. population (Table 2). CONCLUSIONS: Men who undergo RP are likely to die of non-prostate cancer causes. Nearly half of patients who survive their prostate cancer will die of a different malignancy. Non-Prostate Cancer Cause of Death N Post-RRP Pts (%) US Population 2007 (%) 32 4.0% 5.3%
Category Accident Alzheimer’s
20
2.5%
3.0%
1
0.1%
0.8%
36
4.4%
5.6%
4
0.5%
1.2%
Chronic respiratory
18
2.2%
5.4%
Diabetes
10
1.2%
3.0%
181
22.4%
25.1%
Assault 0.9 (0.3–2.5)
0.9 (0.2–3.5)
2.6 (0.7–10.2)
Cerebrovascular Chronic liver
2.7 (1.5–4.7)
3.6 (2.2–5.8)
3.9 (2.1–7.2)
4.7 (2.7–8.2)
17.9 (10.5–29.5)
20.1 (12.3–31.7)
Diseases of the heart Hypertension Malignant neoplasm Nephritis
1.04 (0.75–1.44) 0.91 (0.59–1.41)
3.95 (2.50–6.24)
HIGH RISK PROSTATE CANCER Patients
342
132
89
31
Other
3.6 (1.2–10.8)
10.0 (5.6–17.4)
6.0 (2.3–15.2)
9.4 (4.6–18.8)
2.14 (1.38–3.31) 2.11 (1.23–3.62)
Source of Funding: None
9.4 (4.6–18.8)
2.11 (1.23–3.62)
7
0.9%
1.9%
99
12.2%
18.5%
13
1.6%
0.8%
11
1.4%
2.1%
Sepsis
6
0.7%
1.4%
Suicide
10
1.2%
1.5%
810
100.0%
100.0%
5.3 (0.8–31.9)
8.2 (2.1–28.9)
1.0% 23.5%
Pneumonia
Category 4.5 (1.9–10.6)
0.7% 44.0%
Parkinsons Disease
Total 5.7 (2.6–12.3)
6 356
Lung
Cancer Death (Excluding Prostate Cancer) N RRP patients (%) US Pop. 2007 (%) 84 23.6% 37.0%
Pancreas
39
11.0%
5.9%
Colon
31
8.7%
9.1%
Lymphoma
34
9.6%
3.5%
Leukemia
16
4.5%
3.5%
Bladder
11
3.1%
2.5%
Liver and Biliary
18
5.1%
3.3%
Kidney/Renal Pelvis
14
3.9%
2.8%
Other
101
28.0%
28.0%
Total
356
100.0%
100.0%