J Korean Med Sci.  2016 Nov;31(11):1802-1807. 10.3346/jkms.2016.31.11.1802.

Cause of Death in Korean Men with Prostate Cancer: an Analysis of Time Trends in a Nationwide Cohort

• Park J
• Suh B
• Shin DW
• Hong JH
• Ahn H

• KMID: 2470278
• DOI: http://doi.org/10.3346/jkms.2016.31.11.1802

Abstract

Despite rapid increase in incidence of prostate cancer (PC) and PC survivors, there are few studies regarding competing causes of death and time trends in Asian population. We conducted a cohort study of 2% nationwide random sample of Korean National Health Insurance employees. A total of 873 patients who had received active treatments, including surgery, radiation therapy (RT) and androgen deprivation therapy (ADT), for newly diagnosed PC between 2003 and 2010 were included. The cause of death was categorized as PC, other cancers, cardiovascular disease, and other causes. During a median follow-up of 4.75 years, 29.4% (257/873) of the study population died. PC, other cancers, cardiovascular disease, and other causes were responsible for 46.3%, 35.4%, 6.6%, and 11.7%, respectively, of the decedents. Significant differences existed in the cause of death among treatment groups (P < 0.001). Only 20% and 9.5% of surgery and RT group died of PC, whereas 63.9% of ADT group died of PC. Other cancers were responsible for 56%, 74.6% and 17.8% of death in the surgery, RT and ADT group, respectively, while cardiovascular disease accounted for 4%, 6.3%, and 7.1% of death in the treatment groups. Analysis of time trends showed that PC-specific death tended to decrease (from 42.9% in 2003 to 23.1% in 2010), whereas non-PC causes tended to increase over the 8 years. Our results are valuable in overviewing causes of death and time trends in Korean PC patients, and planning future health policy for PC.

Keyword

Prostate Cancer; Cause of Death; Mortality; Prostatectomy; Radiation Therapy; Androgen Deprivation Therapy

MeSH Terms

Adult
Aged
Asian Continental Ancestry Group
Cardiovascular Diseases/diagnosis/mortality
Cause of Death/*trends
Cohort Studies
Databases, Factual
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Prostatectomy
Prostatic Neoplasms/*diagnosis/mortality/therapy
Republic of Korea
Risk Factors
Young Adult

Figure

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  Fig. 1 Cause of death in Korean men with prostate cancer.

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  Fig. 2 Kaplan-Meier survival curves stratified by primary treatment modalities. (A) Overall survival, (B) Prostate cancer-specific survival.

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  Fig. 3 Time trends in cause of death in Korean men with prostate cancer.

Reference

1. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Prediction of cancer incidence and mortality in Korea, 2014. Cancer Res Treat. 2014; 46:124–130.

2. Jung KW, Won YJ, Kong HJ, Oh CM, Cho H, Lee DH, Lee KH. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat. 2015; 47:127–141.

3. Yoo DS, Woo SH, Cho S, Kang SH, Kim SJ, Park SY, Lee SH, Jeon SH, Park J. Practice patterns of urologists in managing Korean men aged 40 years or younger with high serum prostate-specific antigen levels. Urology. 2014; 83:1339–1343.

4. Park SK, Sakoda LC, Kang D, Chokkalingam AP, Lee E, Shin HR, Ahn YO, Shin MH, Lee CW, Lee DH, et al. Rising prostate cancer rates in South Korea. Prostate. 2006; 66:1285–1291.

5. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, Kwiatkowski M, Lujan M, Lilja H, Zappa M, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009; 360:1320–1328.

6. Andriole GL, Crawford ED, Grubb RL 3rd, Buys SS, Chia D, Church TR, Fouad MN, Gelmann EP, Kvale PA, Reding DJ, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009; 360:1310–1319.

7. Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, Holmberg L, Kantoff P, Konety BR, Murad MH, et al. Early detection of prostate cancer: AUA Guideline. J Urol. 2013; 190:419–426.

8. O’Farrell S, Garmo H, Holmberg L, Adolfsson J, Stattin P, Van Hemelrijck M. Risk and timing of cardiovascular disease after androgen-deprivation therapy in men with prostate cancer. J Clin Oncol. 2015; 33:1243–1251.

9. Bosco C, Bosnyak Z, Malmberg A, Adolfsson J, Keating NL, Van Hemelrijck M. Quantifying observational evidence for risk of fatal and nonfatal cardiovascular disease following androgen deprivation therapy for prostate cancer: a meta-analysis. Eur Urol. 2015; 68:386–396.

10. Azoulay L, Yin H, Benayoun S, Renoux C, Boivin JF, Suissa S. Androgen-deprivation therapy and the risk of stroke in patients with prostate cancer. Eur Urol. 2011; 60:1244–1250.

11. Davis EJ, Beebe-Dimmer JL, Yee CL, Cooney KA. Risk of second primary tumors in men diagnosed with prostate cancer: a population-based cohort study. Cancer. 2014; 120:2735–2741.

12. Skolarus TA, Wolf AM, Erb NL, Brooks DD, Rivers BM, Underwood W 3rd, Salner AL, Zelefsky MJ, Aragon-Ching JB, Slovin SF, et al. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin. 2014; 64:225–249.

13. Newschaffer CJ, Otani K, McDonald MK, Penberthy LT. Causes of death in elderly prostate cancer patients and in a comparison nonprostate cancer cohort. J Natl Cancer Inst. 2000; 92:613–621.

14. Fowler JE Jr, Terrell FL, Renfroe DL. Co-morbidities and survival of men with localized prostate cancer treated with surgery or radiation therapy. J Urol. 1996; 156:1714–1718.

15. Ketchandji M, Kuo YF, Shahinian VB, Goodwin JS. Cause of death in older men after the diagnosis of prostate cancer. J Am Geriatr Soc. 2009; 57:24–30.

16. Satariano WA, Ragland KE, Van Den Eeden SK. Cause of death in men diagnosed with prostate carcinoma. Cancer. 1998; 83:1180–1188.

17. Albertsen PC, Hanley JA, Gleason DF, Barry MJ. Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA. 1998; 280:975–980.

18. Lu-Yao G, Stukel TA, Yao SL. Changing patterns in competing causes of death in men with prostate cancer: a population based study. J Urol. 2004; 171:2285–2290.

19. Shin DW, Cho J, Yang HK, Park JH, Lee H, Kim H, Oh J, Hwang S, Cho B, Guallar E. Impact of continuity of care on mortality and health care costs: a nationwide cohort study in Korea. Ann Fam Med. 2014; 12:534–541.

20. Park J, Suh B, Shin DW, Hong JH, Ahn H. Changing patterns of primary treatment in Korean men with prostate cancer over 10 years: a nationwide population based study. Cancer Res Treat. 2016; 48:899–906.

21. Jung KW, Won YJ, Kong HJ, Oh CM, Shin A, Lee JS. Survival of Korean adult cancer patients by stage at diagnosis, 2006-2010: national cancer registry study. Cancer Res Treat. 2013; 45:162–171.

22. Byun SS, Lee S, Lee SE, Lee E, Seo SI, Lee HM, Choi HY, Song C, Ahn H, Choi YD, et al. Recent changes in the clinicopathologic features of Korean men with prostate cancer: a comparison with Western populations. Yonsei Med J. 2012; 53:543–549.

23. Dong C, Hemminki K. Second primary neoplasms in 633,964 cancer patients in Sweden, 1958-1996. Int J Cancer. 2001; 93:155–161.

24. D’Amico AV, Schultz D, Loffredo M, Dugal R, Hurwitz M, Kaplan I, Beard CJ, Renshaw AA, Kantoff PW. Biochemical outcome following external beam radiation therapy with or without androgen suppression therapy for clinically localized prostate cancer. JAMA. 2000; 284:1280–1283.

25. Kim DS, Jeon SH, Chang SG, Lee SH. Comparison of biochemical recurrence in prostate cancer patients treated with radical prostatectomy or radiotherapy. Korean J Urol. 2015; 56:703–709.

26. Daskivich TJ, Chamie K, Kwan L, Labo J, Palvolgyi R, Dash A, Greenfield S, Litwin MS. Overtreatment of men with low-risk prostate cancer and significant comorbidity. Cancer. 2011; 117:2058–2066.

27. Loeb S, Bjurlin MA, Nicholson J, Tammela TL, Penson DF, Carter HB, Carroll P, Etzioni R. Overdiagnosis and overtreatment of prostate cancer. Eur Urol. 2014; 65:1046–1055.