Mo. Koch et al., ARE WE SELECTING THE RIGHT PATIENTS FOR TREATMENT OF LOCALIZED PROSTATE-CANCER - RESULTS OF AN ACTUARIAL ANALYSIS, Urology, 51(2), 1998, pp. 197-202
Ojectives. To determine our accuracy in selecting patients with at lea
st a 10-year life expectancy for aggressive treatment of localized pro
state cancer. Methods. The medical records of 261 consecutive patients
who underwent radical retropubic prostatectomy were submitted to the
actuarial division of American General Life and Accident Insurance Com
pany (AGLA) for estimation of life expectancy, excluding the diagnosis
of prostate cancer. Survival curves were generated from predicted ind
ividual survivals. In patients with less than a 10-year life expectanc
y, AGLA provided us with the basis for assigning suboptimal survival r
ates, Results. The mean life expectancy for the group was 15.2 years.
Two hundred ten men (80%) were projected to have a life expectancy of
more than 10 years, including 27 of 55 (49%) and 4 of 8 (50%) men who
were older than or equal to 70 and 75 years of age, respectively. Coro
nary artery disease and diabetes mellitus were the most common coexist
ing medical conditions that adversely affected risk as single disease
entities. Conclusions. Although clinicians do not estimate life expect
ancy with the scientific exactitude of an actuary, the ability to asse
ss the patient in person and assimilate pertinent medical information
in a less rigid format yields similar results. Selection of men for de
finitive treatment of localized prostate cancer should be based on the
inherent aggressiveness of the disease and the health of the individu
al and should not be limited by specific age cutoffs. Populations of m
en undergoing radical prostatectomy are younger and healthier than tho
se in reported series of watchful waiting for prostate cancer. (C) 199
8, Elsevier Science Inc. All rights reserved.