Mortality from Non-Prostate Cancer Causes in White Men with Metastatic Disease
The available evidence does not provide a specific percentage of deaths from non-prostate cancer causes specifically for white men with metastatic prostate cancer at 5 years, but extrapolating from the best available data suggests approximately 15-25% of deaths are from non-cancer causes in this population.
Key Evidence on Cause-Specific Mortality
Overall Metastatic Prostate Cancer Population
In a comprehensive U.S. population-based study of 26,168 men with metastatic prostate cancer (2000-2016), 77.8% of deaths were from prostate cancer, 5.5% from other cancers, and 16.7% from non-cancer causes 1
The 5-year survival rate for distant metastatic prostate cancer improved from 28.7% during 2001-2005 to 32.3% during 2011-2016, with white men having a 5-year survival of 29.1% 2
A recent JAMA review reported that metastatic prostate cancer has a 5-year survival rate of 37% overall 3
Race-Specific Considerations
White men with distant stage prostate cancer had a 5-year survival of 29.1% during 2001-2016, which was lower than Asian/Pacific Islanders (42.0%) and Hispanics (37.2%), but similar to Black men (31.6%) 2
Among men with metastatic prostate cancer, the most common non-cancer causes of death were cardiovascular diseases (SMR 1.34), chronic obstructive pulmonary disease (SMR 1.19), and cerebrovascular diseases (SMR 1.31) 1
Temporal Distribution of Deaths
Most deaths (59.0%) in metastatic prostate cancer occur within 2 years of diagnosis, with 31.6% occurring 2-5 years after diagnosis and only 9.4% occurring more than 5 years after diagnosis 1
Among men with distant prostate cancer, 90% of deaths occurred within 5 years of diagnosis 4
Clinical Calculation
Given that 38% of white men with metastatic prostate cancer survive to 5 years, this means 62% died by 5 years. If we apply the population-based finding that 16.7% of all deaths in metastatic prostate cancer are from non-cancer causes 1, then approximately 10-11% of the original cohort died from non-prostate cancer causes (62% × 16.7% ≈ 10.4%).
However, this calculation has important limitations:
- The 16.7% non-cancer death proportion includes all follow-up periods, not just the first 5 years 1
- Men with metastatic disease are at heightened risk for death from non-cancer causes (SMR 1.50) compared to the general population, particularly cardiac-related death (SMR 1.48) and suicide (SMR 2.32) 4
- The proportion of non-cancer deaths may be higher in longer-term survivors who make it past the initial high-risk period 1
Important Clinical Caveats
Competing mortality risks are substantial even in metastatic disease. Despite the aggressive nature of metastatic prostate cancer, cardiovascular disease remains a significant cause of death, and men with metastatic disease face elevated risks for multiple non-cancer causes of death compared to age-matched controls 1, 4
The answer varies significantly by time from diagnosis. Early deaths (within 2 years) are predominantly from prostate cancer, while the proportion of non-cancer deaths increases among longer-term survivors 1