A recent study out of Sweden found that people diagnosed with nonmetastatic low-risk prostate cancer later in life were 90% more likely to survive their cancer for their remaining life expectancy if they were treated according to NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Of those with nonmetastatic higher-risk cancer and a longer life expectancy, the likelihood was still greater than 65%. The aim of the study was to estimate the risk of death from prostate cancer and other causes up to 30 years after treatment initiation in patients with nonmetastatic prostate cancer who received guideline-adherent care.
“Our data support adherence to guideline recommendations for treatment of prostate cancer,” said lead researcher Pietro Scilipoti, MD, of Uppsala University in Sweden and IRCCS San Raffaele Hospital in Italy. “If guideline-recommended treatment is used, most people with prostate cancer will live for many years after diagnosis. That includes active surveillance as an excellent treatment strategy for appropriately selected people.”
Study Details
In the study, which was reported in JNCCN, researchers examined 62,839 people diagnosed with nonmetastatic prostate cancer between 2000 and 2020. All participants were categorized by risk level, had a life expectancy exceeding 3 years, and were treated according to evidence-based, expert consensus–driven recommendations from the NCCN Guidelines for Prostate Cancer. The most common treatment was radical prostatectomy (42%; n = 26,218), followed by radiotherapy plus androgen-deprivation therapy (22%; n = 13,623) and active surveillance (20%; n = 12,603).
Key Findings
Those with low- and intermediate-risk cancer were six times more likely to die of other causes than prostate cancer. Those with high-risk cancer were twice as likely to die of other causes. Key metrics, including Gleason score/Grade Group, clinical TNM stage, and treatment data, were sourced from the National Prostate Cancer Register (NPCR) of Sweden. Life expectancy at the time of diagnosis was calculated based on age and comorbidity. Date and cause of death were taken from the Cause of Death Register.
“This study offers a big sigh of relief for many men facing a prostate cancer diagnosis,” commented Ahmad Shabsigh, MD, of The Ohio State University Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute, and Member of the NCCN Guidelines Panel for Prostate Cancer, who was not involved with this research. “It reveals that with NCCN Guidelines–recommended treatment, you're significantly more likely to die from something else—up to six times more likely, in fact—even if your cancer is high risk. This holds true even when looking at data from a different health-care system, like Sweden's. What's truly striking is that for patients with low-risk prostate cancer, many of whom were on active surveillance, the 30-year mortality risk from the cancer itself was only about 11%. It really underscores the power of evidence-based treatment plans and the importance of focusing on a person's overall health, not just their cancer.”
The researchers concluded: “Men with nonmetastatic [prostate cancer] who received primary treatment according to current NCCN Guidelines (v4.2023) were up to six times more likely to die of other causes than from their cancer. Men with long life expectancy, even those with very high-risk cancer, were twice as likely to die of other causes than from [prostate cancer]. Our estimates of [prostate cancer–]specific and other-cause mortality, extending up to 30 years after diagnosis, offer realistic yet high expectations for the outcomes of modern treatment and can serve as benchmarks for clinical outcome reporting.”
Disclosure: For full disclosures of the study authors, visit jnccn.org.
