Predicting Life Expectancy in Men Diagnosed with Prostate Cancer

Area of Science:

• Oncology
• Public Health
• Biostatistics

Background:

• Prostate-specific antigen (PSA) screening detects more indolent prostate cancer (PCa), necessitating a balance between treatment benefits and harms.
• Accurate estimation of life expectancy (LE) is fundamental for physicians to guide PCa screening and treatment decisions.
• Understanding LE differences between PCa patients and the general population is critical for personalized care.

Purpose of the Study:

• To review existing evidence comparing LE in men diagnosed with PCa versus the general population.
• To evaluate the accuracy of clinician- and model-predicted LE for PCa patients.
• To assess the utility of publicly available LE calculators.

Main Methods:

• A systematic literature review adhering to PRISMA guidelines was conducted using PubMed (1990-2014).
• Search terms included 'life expectancy prostate cancer', 'non-cancer mortality prostate', and 'comorbidity-adjusted life expectancy'.
• Publicly available LE calculators were identified and evaluated through internet searches.

Main Results:

• Men with localized PCa showed prolonged LE, while those with distant disease had shorter LE compared to age-matched peers.
• Clinician-predicted 10-year LE was generally pessimistic and inaccurate; statistical models offered modest improvements (c-index 0.65-0.84).
• Online LE calculators provided consistent estimates, but government life tables yielded similar results to the mean of examined calculators.

Conclusions:

• The accuracy of clinician-predicted survival in PCa patients is limited.
• While statistical models may improve survival discrimination, their advantage over government life tables remains uncertain.
• Current predictive tools for PCa LE may not surpass readily available government life tables.