Morbidity in patients with clinically localized prostate cancer managed with non-curative intent. A population-based case-control study

To compare the morbidity in patients with newly diagnosed clinically locali zed prostate cancer managed conservatively with the morbidity in a randomly selected age-matched background population with no history of prostate can cer. Patients younger than 75y at diagnosis with newly diagnosed clinically loca lized prostate cancer reported to the Danish Cancer Registry in the period 1977-1992. Morbidity in patients and age-matched controls was extracted fro m The Danish Hospital Discharge Registry. Admissions were stratified by dis charge diagnosis. Overall 4744 patients were hospitalized for 251,695 days within the first 1 0y following diagnosis compared with 74,563 days in 4774 age-matched contro ls. The patients were admitted 6.7 (6.4-7.1) times more often than controls in the year following diagnosis, and 2.7 (2.6-2.8) times more often in the following 9 y. Excess morbidity declined over time. When prostate cancer-r elated admissions were excluded, the relative risk of admission was reduced to 1.35 (1.3-1.4) and 0.86 (0.83-0.89), respectively. The estimated costs associated with deferred therapy in patients with clinically localized pros tate cancer exceeded the estimated cost in age-matched controls by approxim ately US$88 million, equivalent to an average extra cost per patient of app roximately US$18,500. Patients with clinically localized prostate cancer managed conservatively h ad a significantly higher morbidity than age-matched controls due to admiss ions associated with prostate cancer. In future comparisons of treatment st rategies, morbidity following treatment and impact on quality of life have to be included when evaluating the outcome.