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Years of Life Lost in Incidental Prostate Cancer
Fabian Falkenbach1,2,3, Mattia Longoni1,4,5, Andrea Marmiroli1,6,7
1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.
Background:
It is unknown how survival is prematurely curtailed by incidental prostate cancer (IPCa). We aimed to quantify the average years of life lost (YLL) due to IPCa.
Methods:
Within the SEER database 2004-2021, IPCa patients aged 45-75 were identified. Stratification was based on the Gleason sum, clinical stage, and active treatment (radical prostatectomy or radiotherapy) status. Monte Carlo simulated individual survival according to the Social Security Administration life tables. Subsequently, YLL was compared between IPCa patients versus controls using the Kaplan-Meier method.
Results:
Of 7324 IPCa patients, 1926 (26.7%) and 5398 (73.7%) received active treatment or no active treatment, respectively. Compared to population controls, IPCa patients exhibited a survival disadvantage of 0.23 YLL (p < 0.001). Patients without active treatment exhibited a larger survival disadvantage of 0.25 YLL, compared to patients with active treatment (0.18 YLL). In subgroup analyses, the largest YLL disadvantage was observed in patients not receiving active treatment with Gleason sum 8-10 (2.67 YLL), clinical stage T1b (0.83 YLL), and both (Gleason sum 8-10, T1b: 3.02 YLL). Conversely, in active treatment patients with Gleason sum ≤ 7 and/or T1a, no YLL disadvantage was observed.
Conclusions:
IPCa patients with advanced Gleason sum or clinical stage exhibited substantial YLL disadvantages, when they did not benefit from active treatment. Therefore, these patients should receive active treatment. Conversely, omitting active treatment in low-risk IPCa patients did not impact premature death.
