ARE WE SELECTING THE RIGHT PATIENTS FOR TREATMENT OF LOCALIZED PROSTATE-CANCER - RESULTS OF AN ACTUARIAL ANALYSIS

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.