Temporal trends in cause of death among Swedish and US men with prostate cancer

Abstract

Background: A growing proportion of men diagnosed with localized prostate cancer detected through prostate-specific antigen testing are dying from causes other than prostate cancer. Temporal trends in specific causes of death among prostate cancer patients have not been well described.

Methods: We analyzed causes of death among all incident prostate cancer cases recorded in the nationwide Swedish Cancer Registry (1961-2008; n = 210 112) and in the US Surveillance, Epidemiology, and End Results Program (1973-2008; n = 490 341). We calculated the cumulative incidence of death due to seven selected causes that accounted for more than 80% of the reported deaths (including ischemic heart disease and non-prostate cancer) and analyzed mortality trends by calendar year and age at diagnosis and length of follow-up.

Results: During follow-up through 2008, prostate cancer accounted for 52% of all reported deaths in Sweden and 30% of reported deaths in the United States among men with prostate cancer; however, only 35% of Swedish men and 16% of US men diagnosed with prostate cancer died from this disease. In both populations, the cumulative incidence of prostate cancer-specific death declined during follow-up, while the cumulative incidences of death from ischemic heart disease and non-prostate cancer remained constant. The 5-year cumulative incidence of death from prostate cancer among all men was 29% in Sweden and 11% in the United States.

Conclusions: In Sweden and the United States, men diagnosed with prostate cancer are less likely to die from prostate cancer than from another cause. Because many of these other causes of death are preventable through changes in lifestyle, interventions that target lifestyle factors should be integrated into prostate cancer management.

Figure 1.

The distribution of cause-specific cumulative incidence of death among Swedish men with prostate cancer by age and year of diagnosis, 1961–2008. *Risk of cause-specific death, does not account for competing risks. Cancer other than prostate cancer; Other causes, including diabetes mellitus, external causes (including trauma and suicide), chronic obstructive pulmonary disease, and all other specified causes.

Figure 2.

The distribution of cause-specific cumulative incidence of death among US men with prostate cancer by year of diagnosis, 1973–2008. *Risk of cause-specific death, does not account for competing risks. Cancer other than prostate cancer; Other causes, including diabetes mellitus, external causes (including trauma and suicide), chronic obstructive pulmonary disease, and all other specified causes.