Abstract B39: Time trends in cause of death among men with prostate cancer in Sweden and the U.S.
Authors: Epstein Mara Meyer , Edgren Gustaf , Rider Jennifer R. , Mucci Lorelei A. , Adami Hans-Olov 
Published: May 2013

Abstract
Purpose: Due to increased diagnostic intensity and widespread PSA testing, the number of prostate cancer patients that are diagnosed with early stage, low risk disease has increased dramatically over the past decades. Because the majority of these men have a very good prognosis, most newly diagnosed patients are likely to die from causes other than prostate cancer. Temporal trends in cause of death among prostate cancer patients have, however, not been well described.
Methods: We analyzed the distribution of causes of death among all incident prostate cancers recorded in the nation-wide Swedish Cancer Register (1961-2008; n = 209,946) and in the US Surveillance, Epidemiology and End Results Program (1973-2008; n = 490,341) with follow-up for mortality through 2008 in both studies. The cumulative incidence of death due to seven selected causes – prostate cancer, ischemic heart disease, cerebrovascular disease, non-prostate cancers, diabetes mellitus, chronic obstructive pulmonary disease, and external causes – was calculated. Trends in cumulative incidence were analyzed by follow-up time, calendar period, and age at diagnosis.
Results: Prostate cancer accounted for 52% of the 143,027 deaths in Sweden and 30% of the 259,021 deaths in the US among men with prostate cancer during the study period. The cumulative incidence of prostate cancer death was 35% among the Swedish prostate cancer patients and 16% in the US. In both populations, ischemic heart disease was the second most common cause of death followed by death from cancers other than prostate. The cumulative incidence of death from prostate cancer declined over time, while ischemic heart disease and cerebrovascular disease remained constant. In contrast, the cumulative incidence of death from non-prostate cancers and from other causes increased at similar levels over time in both populations. Among men diagnosed at older ages (≥75) in both populations, the cumulative incidence of death from other causes (44% in Sweden, 55% in US) was higher than that of prostate cancer (38% in Sweden, 21% in US). In contrast, the cumulative incidence of death from prostate cancer (28%) was higher among Swedish men diagnosed at younger ages (≤60) compared to other causes (15%). However, in the US, the cumulative incidence of death from other causes (12%) remained higher than that of prostate cancer (10%) among men diagnosed at age 60 or younger. We also saw trends by calendar time, with a lower cumulative incidence of death due to prostate cancer among men diagnosed in the PSA era, compared to the pre-PSA era (1991 in US, 1994 in Sweden) in both populations; these trends persisted both with ≥5 and ≥10 years of follow-up time.
Conclusion: Among patients with prostate cancer, other causes of death have become increasingly common over the past decades. In fact, among men diagnosed in recent years, the majority will die of causes other than prostate cancer. Because many of these causes are preventable, lifestyle intervention should become integrated in the management of patients with prostate cancer. Such interventions might indeed prevent more deaths than prevailing curative treatments for prostate cancer.
Citation Format: Mara Meyer Epstein, Gustaf Edgren, Jennifer R. Rider, Lorelei A. Mucci, Hans-Olov Adami. Time trends in cause of death among men with prostate cancer in Sweden and the U.S [abstract]. In: Proceedings of the AACR Special Conference on Advances in Prostate Cancer Research; 2012 Feb 6-9; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2012;72(4 Suppl):Abstract nr B39.