Abstract
BACKGROUND: Guidelines endorse specific life expectancy (LE) cutoffs for triage of definitive local treatment of prostate cancer, but the lack of validated, prostate cancer-specific LE prediction tools limits incorporation of LE in management decisions. OBJECTIVE: We sought to provide long-term LE predictions in older men using the Prostate Cancer Comorbidity Index (PCCI), a validated tool for prediction of other-cause mortality based on age and presence and severity of major comorbidities, in nationally representative cohorts of US prostate cancer patients. DESIGN, SETTING, SUBJECTS: We performed an observational study of 916,890 men in the SEER-Medicare database and 243,928 men in the VA diagnosed with clinically localized prostate cancer between 2000 and 2019. METHODS: PCCI scores were calculated using ICD-9 and ICD-10 codes. Kaplan Meier and multivariable Cox proportional hazards analysis were used to measure overall survival by age-adjusted PCCI score groups. RESULTS: Median follow up was 11 years in both cohorts. In SEER-Medicare, men with PCCI scores of 1-2, 3-4, 5-6, 7-9, and 10+ had median estimated LE (95%CI) of 16.6 (16.5-16.7), 12.2 (12.1-12.2), 10.7 (10.6-10.7), 9.3 (9.2-9.3), and 5.4 (5.3-5.4) years, respectively. In the VA, men with the same PCCI scores had estimated median LE (95%CI) of 16.1 (16.0-16.3), 11.2 (11.1-11.4), 9.1 (8.9-9.2), 7.5 (7.4-7.7), and 5.2 (5.0-5.3) years, respectively. CONCLUSIONS: The PCCI robustly predicts long-term longevity in SEER-Medicare and VA populations, with similar LE estimates in each. LE prediction tables with their accompanying variability estimates can help clinicians implement guidelines endorsed LE cutoffs for management of older men with prostate cancer.