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. 2021 Aug 2;4(8):e2119568.
doi: 10.1001/jamanetworkopen.2021.19568.

Causes of Death Among Patients With Metastatic Prostate Cancer in the US From 2000 to 2016

Ahmed O Elmehrath  1 , Ahmed M Afifi  2   3 , Muneer J Al-Husseini  4 , Anas M Saad  3   5 , Nathaniel Wilson  6 , Kyrillus S Shohdy  7 , Patrick Pilie  8 , Mohamad Bassam Sonbol  9 , Omar Alhalabi  8
Affiliations

Causes of Death Among Patients With Metastatic Prostate Cancer in the US From 2000 to 2016

Ahmed O Elmehrath et al. JAMA Netw Open. .

Abstract

Importance: Owing to improved survival among US patients with prostate cancer (PC), patients tend to live long enough after a PC diagnosis for non-cancer-related comorbidities to be associated with their overall survival. Although studies have investigated causes of death among patients with localized PC, data are lacking regarding causes of death among patients with metastatic PC.

Objective: To assess causes of death among US patients with metastatic PC from 2000 to 2016.

Design, setting, and participants: This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results Program database to analyze a sample of 26 168 US men who received a diagnosis of metastatic PC from January 1, 2000, to December 31, 2016. Data were analyzed from February 2 to July 28, 2020.

Exposure: Diagnosis of metastatic PC.

Main outcomes and measures: Standardized mortality ratios (SMRs) for different causes of death were calculated by dividing the observed number of deaths from each cause of death by the expected number of deaths in the age-matched US male population for the same period, adjusting for age and race/ethnicity.

Results: Of 26 168 patients with metastatic PC included in the analysis, 48.9% were aged 50 to 70 years (mean age at diagnosis, 70.83 years); 74.5% were White individuals, and 72.7% received a diagnosis of stage M1b metastatic PC. A total of 16 732 patients (63.9%) died during the follow-up period. The mean age at death was 74.13 years. Most deaths (59.0%) occurred within the latency period of 2 years after diagnosis of metastatic PC, whereas 31.6% occurred 2 to 5 years after diagnosis and 9.4% occurred more than 5 years after diagnosis. Of the total deaths, 13 011 (77.8%) were from PC, 924 (5.5%) were from other cancers, and 2797 (16.7%) were from noncancer causes. During all latency periods, the most common noncancer causes of death were cardiovascular diseases (SMR, 1.34; 95% CI, 1.26-1.42), chronic obstructive pulmonary disease (SMR, 1.19; 95% CI, 1.03-1.36), and cerebrovascular diseases (SMR, 1.31; 95% CI, 1.13-1.50).

Conclusions and relevance: In this cohort study, deaths from noncancer causes, including cardiovascular disease, constituted a substantial number of deaths among men with metastatic PC. Therapy and follow-up should be tailored to the needs of each patient with metastatic PC, and counseling regarding future health risks should be provided.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Pilie reported receiving grant funding from the Prostate Cancer Foundation unrelated to this work. Dr Alhalabi reported receiving grant funding from the American Society of Clinical Oncology Conquer Cancer Foundation unrelated to this work. No other disclosures were reported.

Figures

Figure.
Figure.. Causes of Death During Each Latency Period After Diagnosis of Metastatic Prostate Cancer
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