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Does increasing life expectancy affect competing mortality after radical prostatectomy?

Michael Froehner1, Rainer Koch2, Manfred P Wirth1

  • 1Department of Urology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.

Urologic Oncology
|December 17, 2013
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Summary
This summary is machine-generated.

Competing mortality after prostatectomy decreased significantly in Germany, particularly for older men, mirroring the nation's rising life expectancy. This trend offers crucial insights for elderly patients considering prostate cancer treatment options.

Keywords:
Active surveillanceCompeting mortalityLife expectancyProstate cancerRadical prostatectomySurvival

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Area of Science:

  • Urology
  • Geriatric Oncology
  • Public Health

Background:

  • Life expectancy in Germany increased by 4.2 years between 1991-1993 and 2004-2006, with greater gains in Eastern Germany.
  • This demographic shift necessitates an evaluation of its impact on patient outcomes following major surgical procedures.

Purpose of the Study:

  • To investigate the extent to which increased life expectancy in Germany correlated with reduced competing mortality rates after radical prostatectomy.
  • To analyze trends in competing mortality over distinct time periods.

Main Methods:

  • A cohort of 6,831 patients undergoing radical prostatectomy between 1992 and 2005 was analyzed.
  • Competing mortality rates at 8 years post-surgery were compared across three time periods: 1992-1995, 1996-2001, and 2002-2005.
  • Statistical analysis utilized the 2-sided Wald test.

Main Results:

  • Eight-year competing mortality rates declined from 7.6% (1992-1995) to 4.7% (2002-2005), with a statistically significant decrease (P=0.0127).
  • When deaths of unknown causes were classified as non-prostate cancer deaths, the rates further decreased from 9.0% to 5.6% (P=0.0107).
  • The reduction in competing mortality was more pronounced in men aged 65 and older, and in those of East German origin.

Conclusions:

  • Competing mortality following radical prostatectomy has decreased, aligning with Germany's overall increase in life expectancy.
  • This trend is particularly evident in older men (≥65 years), suggesting improved management of comorbidities and surgical risks.
  • These findings are vital for informing treatment decisions for elderly patients with early-stage prostate cancer, especially regarding the balance between curative interventions and watchful waiting.