A method for using life tables to estimate lifetime risk for prostate cancer death

Prostate cancer can have a long and indolent course, and management without curative therapy should be considered in select patients. When counseling patients, a useful way to convey the risk for death from competing causes is to estimate their lifetime risk for dying from prostate cancer. Double-decrement life tables were constructed to calculate age-specific death rates using the death probabilities from the Social Security Administration life tables and Gleason score-specific mortality rates reported from a pre-PSA cohort study. The lifetime risk for prostate cancer death was calculated. Life tables provided life expectancy and risk for prostate cancer death based on age at diagnosis. For example, a 60-year-old patient with a Gleason score 6, 7, or 8 tumor had an overall life expectancy of 14.4, 10.2, or 6.6 years, respectively. The risk for prostate cancer death during the expected years of life was 33%, 49%, or 57%, respectively. If a 10-year lead-time bias was assumed for PSA detection, the risks for death from prostate cancer decreased to 16%, 26%, or 37%, respectively. If the patient was in the bottom quartile for overall health and disease was detected by prostate examination, the risk for death from prostate cancer was 21%, 32%, or 40%, respectively. A Web-based tool for performing these calculations is available at http://www.roswellpark.org/Patient_Care/Specialized_Services/Prostate_Cancer_Estimator.html. Life tables can be created to estimate overall life expectancy and risk for prostate cancer death, and to assist with decision-making when considering management without curative therapy.