Which patients are at the highest risk of dying from competing causes ≤ 10 years after radical prostatectomy?

Study Type - Outcomes (cohort). Level of Evidence 2b. What's known on the subject? and What does the study add? Several comorbidity classifications have been investigated for their suitability to assist treatment decision-making in men with early prostate cancer. In unselected patients, some serious comorbidities have been shown to be associated with a 10-year competing mortality rate clearly superseding the 50% level. The present study shows that it is hardly possible to discern meaningful subsets of patients with a 10-year risk of competing mortality of >50% by using comorbidity classifications. This finding suggests that the selecting clinicians did well in estimating the medium-term survival probability in men referred for radical prostatectomy.

• To identify subsets of patients who are most likely to die from competing causes ≤ 10 years after radical prostatectomy (RP).

• In all, 2205 consecutive patients who underwent RP for clinically localized prostate cancer between 1992 and 2005 were studied. The 10-year cumulative competing mortality rates were determined in several worst-case scenarios formed by using comorbidity classifications and combinations of them.

• In this sample of men selected for RP, even those with the most severe comorbidity level had a competing mortality risk of <50% ≤ 10 years after RP. • Depending on the comorbidity classification used, the 10-year cumulative competing mortality rates differed between 16 and 39% in the whole sample and between 18 and 48% in men aged ≥ 65 years.

• Clinicians do well in estimating the further life span in candidates for RP. Comorbidity classifications may assist treatment choice in this population but are not able to discern meaningful subsets to be excluded from curative treatment because of a life expectancy falling below a limit of 10 years.