High Norwegian prostate cancer mortality: evidence of over-reporting

Figures & data

Table 1. First review of patient history: definition of death from other causes for patients with prostate cancer as underlying of immediate cause of death (PCD, n = 328) and corresponding results.

	No. of patients (%)
No histological or clinical diagnosis of prostate cancer	15 (4.6)
Watchful waiting with no significant disease activity	13 (4)
Previous radical treatment with no disease recurrence and an immediate cause of death not related to treatment	5 (1.5)
Hormone therapy with complete response to treatment and an immediate cause of death unrelated to hormone therapy, and other	33 (10.1)
Other, clinically more significant metastatic malignancies	4 (1.2)
Total	70 (21.3)

Table 2. Comparison of clinical characteristics of patients with prostate cancer as the immediate or underlying cause of death according to the death certificate (PCD), patients with prostate cancer as other significant condition at death (OCD) and patients with prostate cancer with no mention of the diagnosis on the death certificate (PC-DCneg).

	PCD patients	OCD patients	PC-DCneg patients
All patients
No. of patients	328	126	310
Age at death (years)	84 (50–97)	84 (59–98)	83 (57–101)
Patients with prostate cancer
No. of patients	313	111	308
Year of diagnosis	1989–2014 (2007)	1988–2014 (2005)	1985–2013 (2005)
Age at diagnosis (years)	76 (48–96)	76 (52–93)	75 (55–96)
Age at death (years)	83 (50–97)	83 (59–98)	83 (57–101)
PSA at diagnosis (µg/l)	34 (0–10 000)	21 (1–2853)	15 (0–4400)
Gleason score at diagnosis
≤ 6	29 (9)	23 (21)	106 (35)
7	102 (33)	36 (32)	119 (39)
8–10	128 (41)	34 (31)	54 (18)
Unknown	54 (17)	18 (16)	29 (9)
T stage
T1	44 (14)	21 (19)	117 (38)
T2	41 (13)	14 (13)	65 (21)
T3	140 (45)	59 (53)	100 (33)
T4	48 (15)	9 (8)	17 (6)
Unknown	40 (13)	8 (7)	9 (3)
Metastatic status at diagnosis
Yes	106 (34)	18 (16)	30 (10)
No	178 (57)	85 (77)	268 (87)
Unknown	29 (9)	8 (7)	10 (3)
Metastatic status at death
Yes	230 (74)	26 (23)	22 (7)
No	63 (20)	84 (76)	279 (91)
Unknown	21 (6)	1 (1)	7 (2)
Primary treatment
Hormone therapy	223 (71)	55 (50)	110 (36)
Radical prostatectomy	11 (4)	9 (8)	26 (8)
Radiation therapy	15 (5)	9 (8)	31 (10)
Watchful waiting	61 (20)	37 (33)	115 (37)
Active surveillance			5 (2)
Autopsy finding			2 (1)
Cystoprostatectomy (bladder cancer)			15 (5)
Other	3 (1)	1 (1)	4 (1)
Time from diagnosis to death (years)	5 (0–22)	6 (0–22)	6 (0–27)
Hormone therapy at death	284 (91)	82 (74)	143 (46)
mCRPC at death	200 (64)	39 (35)	40 (13)

Data are shown as n, median (range) or n (%).

PSA: prostate-specific antigen; mCRPC: metastatic castration-resistant prostate cancer.

Figure 1. Total number of patients registered as dead from prostate cancer per age group: patients dead from prostate cancer (blue), patients dead from other causes (green) and patients whose cause of death was not possible to determine (yellow).

Figure 2. Total number of patients registered as dead from other causes per age group: patients dead from prostate cancer (blue), patients dead from other causes (green) and patients whose cause of death was not possible to determine (yellow).

Table 3. Results of the review process for patients with prostate cancer as the immediate or underlying cause of death (PCD) (n = 328).

Prostate cancer death	First review		Second review		Third review		Final result
	% (95% CI)	n	% (95% CI)	n	% (95% CI)	n	% (95% CI)	n
Yes	58 (52–63)	189	60 (54–65)	195	62 (56–67)	202	67 (61–72)	218
No	21 (17–26)	70	26 (21–31)	85	29 (24–34)	94	32 (27–37)	105
Likely	–	–	2 (1–4.5)	7	5 (3–8)	16	–	–
Unlikely	–	–	0.3 (0–2)	1	3 (2–6)	11	–	–
Not possible to determine	–	–	0.6 (0–2)	2	2 (1–4)	5	2 (1–3)	5
Further discussion needed	21 (16–26)	69	12 (8–16)	38	–	–	–	–

CI: confidence interval.

Table 4. Results of the review process for patients with prostate cancer as other significant condition at death (OCD) (n = 126).

Prostate cancer death	First review		Second review		Third review		Final result
	% (95% CI)	n	% (95% CI)	n	% (95% CI)	n	% (95% CI)	n
Yes	14 (8–21)	17	15 (10–23)	19	16 (10–24)	20	18 (12–26)	23
No	66 (57–74)	83	72 (63–79)	90	75 (66–82)	94	79 (70–85)	99
Likely	–	–	0.8 (0–5)	1	2 (1–7)	3	–	–
Unlikely	–	–	2 (0–6)	2	4 (2–10)	5	–	–
Not possible to determine	–	–	0.8 (0–5)	1	3 (1–8)	4	3 (1–8)	4
Further discussion needed	21 (14–29)	26	10 (6–17)	13	–	–	–	–

CI: confidence interval.

Figure 3. Patient transition from the original group of patients registered as dead from prostate cancer (PCD) and formation of the group of patients observed dead from prostate cancer. OCD: dead from other causes; PC-DCneg: prostate cancer not registered on the death certificate.