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Geriatrics
2316
GERIATRICS
Geriatrics Cause of Death in Older Men After the Diagnosis of Prostate Cancer M. Ketchandji, Y. F. Kuo, V. B. Shahinian and J. S. Goodwin University of Texas Medical Branch, Galveston, Texas J Am Geriatr Soc 2009; 57: 24 –30.
Objectives: To compare survival and cause of death in men aged 65 and older diagnosed with prostate cancer and with survival and cause of death in a noncancer control population. Design: Retrospective cohort from a population-based tumor registry linked to Medicare claims data. Setting: Eleven regions of the Surveillance, Epidemiology and End Results (SEER) Tumor Registry. Participants: Men aged 65 to 84 (N⫽208,601) diagnosed with prostate cancer from 1988 through 2002 formed the basis for different analytical cohorts. Measurements: Survival as a function of stage and tumor grade (low, Gleason grade⬍7; moderate, grade⫽7; and high, grade⫽8 –10) was compared with survival in men without any cancer using Cox proportional hazards regression. Cause of death according to stage and tumor grade were compared using chi-square statistics. Results: Men with early-stage prostate cancer and with low- to moderate-grade tumors (59.1% of the entire sample) experienced a survival not substantially worse than men without prostate cancer. In those men, cardiovascular disease and other cancers were the leading causes of death. Conclusion: The excellent survival of older men with early-stage, low- to moderate-grade prostate cancer, along with the patterns of causes of death, implies that this population would be well served by an ongoing focus on screening and prevention of cardiovascular disease and other cancers. Editorial Comment: Screening efforts, including use of prostate specific antigen testing and digital rectal examination, have significantly increased the rates of prostate cancer detection and diagnosis among older men. Although metastatic prostate cancer still develops in many men, and many certainly still die of it, rates have generally decreased during the last 20 years. This study was designed to assess survival and cause of death in men older than 65 years who were diagnosed with prostate cancer compared to a control group. Data from the SEER tumor registry were analyzed retrospectively. Overall, men with low grade and early stage prostate cancers had survival rates comparable to controls. Cardiovascular disease remained the leading overall cause of death in both groups, although men with high stage and high grade prostate cancer were more likely to die of that disease. Other nonprostate malignancies were also a common cause of death in this series. The authors concluded that, particularly for men with low stage and low grade prostate cancer, screening and treatment for cardiovascular disease and other cancers should remain a clinical priority. These results support the longstanding argument that the majority of men with prostate cancer will die with rather than of the disease. However, the results need to be interpreted with caution, and should not diminish the important role of screening and treatment of prostate cancer from a population perspective. Treatment options for elderly men diagnosed with prostate cancer need to be considered carefully in the context of overall general health and concomitant health problems. Tomas L. Griebling, M.D., M.P.H.
GERIATRICS
Geriatrics Cause of Death in Older Men After the Diagnosis of Prostate Cancer M. Ketchandji, Y. F. Kuo, V. B. Shahinian and J. S. Goodwin University of Texas Medical Branch, Galveston, Texas J Am Geriatr Soc 2009; 57: 24 –30.
Objectives: To compare survival and cause of death in men aged 65 and older diagnosed with prostate cancer and with survival and cause of death in a noncancer control population. Design: Retrospective cohort from a population-based tumor registry linked to Medicare claims data. Setting: Eleven regions of the Surveillance, Epidemiology and End Results (SEER) Tumor Registry. Participants: Men aged 65 to 84 (N⫽208,601) diagnosed with prostate cancer from 1988 through 2002 formed the basis for different analytical cohorts. Measurements: Survival as a function of stage and tumor grade (low, Gleason grade⬍7; moderate, grade⫽7; and high, grade⫽8 –10) was compared with survival in men without any cancer using Cox proportional hazards regression. Cause of death according to stage and tumor grade were compared using chi-square statistics. Results: Men with early-stage prostate cancer and with low- to moderate-grade tumors (59.1% of the entire sample) experienced a survival not substantially worse than men without prostate cancer. In those men, cardiovascular disease and other cancers were the leading causes of death. Conclusion: The excellent survival of older men with early-stage, low- to moderate-grade prostate cancer, along with the patterns of causes of death, implies that this population would be well served by an ongoing focus on screening and prevention of cardiovascular disease and other cancers. Editorial Comment: Screening efforts, including use of prostate specific antigen testing and digital rectal examination, have significantly increased the rates of prostate cancer detection and diagnosis among older men. Although metastatic prostate cancer still develops in many men, and many certainly still die of it, rates have generally decreased during the last 20 years. This study was designed to assess survival and cause of death in men older than 65 years who were diagnosed with prostate cancer compared to a control group. Data from the SEER tumor registry were analyzed retrospectively. Overall, men with low grade and early stage prostate cancers had survival rates comparable to controls. Cardiovascular disease remained the leading overall cause of death in both groups, although men with high stage and high grade prostate cancer were more likely to die of that disease. Other nonprostate malignancies were also a common cause of death in this series. The authors concluded that, particularly for men with low stage and low grade prostate cancer, screening and treatment for cardiovascular disease and other cancers should remain a clinical priority. These results support the longstanding argument that the majority of men with prostate cancer will die with rather than of the disease. However, the results need to be interpreted with caution, and should not diminish the important role of screening and treatment of prostate cancer from a population perspective. Treatment options for elderly men diagnosed with prostate cancer need to be considered carefully in the context of overall general health and concomitant health problems. Tomas L. Griebling, M.D., M.P.H.