Mortality from Non-Prostate Cancer Causes in Metastatic Disease
When overall survival is 38% at 5 years in men with metastatic prostate cancer, approximately 13-17% of deaths are from causes unrelated to prostate cancer, meaning roughly 78% of deaths are prostate cancer-specific.
Evidence-Based Mortality Breakdown
The most relevant data comes from a large cohort study examining causes of death in metastatic prostate cancer patients:
In men with metastatic prostate cancer, 77.8% of deaths were from prostate cancer itself, while 16.7% were from non-cancer causes and 5.5% from other cancers 1
Among non-cancer deaths, cardiovascular diseases were the leading cause (standardized mortality ratio 1.34), followed by chronic obstructive pulmonary disease and cerebrovascular diseases 1
Calculating Non-Prostate Cancer Deaths
Using the 38% 5-year survival rate scenario:
- If 62% died within 5 years (100% - 38% = 62% mortality)
- Approximately 78% of these deaths were prostate cancer-related (based on the 77.8% figure) 1
- This means roughly 48% died from prostate cancer (62% × 0.78)
- Therefore, approximately 14% died from other causes (62% - 48%)
Temporal Patterns of Death
Most deaths (59%) occur within 2 years of metastatic diagnosis, with 31.6% occurring 2-5 years after diagnosis 1
The proportion of non-prostate cancer deaths increases with longer survival, as patients who live longer have more opportunity to die from competing causes 1, 2
Risk Factors for Non-Prostate Cancer Death
Patients more likely to die from causes other than prostate cancer include those with:
- Concurrent cardiovascular disease at diagnosis - the strongest predictor of non-cancer death 2
- Older age at diagnosis (>75 years) 2
- Less advanced disease stage at presentation 2
- White race compared to Black race 2
Clinical Context
In historical cohorts with longer follow-up, approximately 46% of men with prostate cancer died from causes other than prostate cancer, though this included all stages 2
For metastatic disease specifically, the proportion dying from prostate cancer is substantially higher (approximately 78%) compared to localized disease 1
Cardiovascular disease accounts for the majority of non-cancer deaths, with a 34% higher mortality rate than the age-matched general population 1