Over 3.6 million men in the United States harbor a diagnosis of prostate cancer (PCa). Understanding causes of death in contemporary survivors is essential for proper survivorship management. Thus, we sought to provide in-depth analyses of the causes of death during PCa survivorship.

Population-based cohort study from the United States (2000-2016) of 752,092 men with PCa was conducted, including 200,302 who died (27%), using the Surveillance, Epidemiology, and End Results database. Cause of death by time following PCa diagnosis stratified by patient demographics and tumor stage. Using general-population data, we calculated standardized mortality ratios (SMRs) as the ratio of observed to expected cause of death.

Among men with local/regional disease, most deaths occurred between 5 and 10 years (38%) following diagnosis. A total of 29,048 (17%) of these men died from PCa while more than 4-fold that died from other causes (n=143,683, 83%; Figure). SMRs for death from non-cancer deaths (0.77, 95%CI 0.77-0.78) suggest these men were less likely than the general population to die from most other causes. The most common non-cancer cause of death was cardiac-related (23%, SMR 0.76, 95% CI 0.75-0.77). Among men with distant PCa, 90% of deaths occurred within 5 years of diagnosis. While death due to PCa comprised the majority of deaths (74%), SMRs suggest these men were at a heightened risk of death from most other non-cancer causes (1.50, 95% CI 1.46-1.54). Risks of cardiac-related deaths (SMR 1.48, 95%CI 1.41-1.54) and suicide (SMR 2.32, 95% CI 1.78-2.96) were elevated. Causes of death varied substantially by patient demographics.

Causes of death during PCa survivorship vary by patient and tumor characteristics and non-PCa causes were 4-fold more frequent among men with local/regional disease. For men with distant disease, the risk of death for most non-PCa causes including cardiac and suicide was greater than that of the general population. These data provide valuable information regarding healthcare prioritization during PCa survivorship.