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    How to estimate life expectancy in men with localized prostate Ca

     

    The current National Comprehensive Cancer Network Guidelines for Prostate Cancer Version 2.2017 endorse “the clinician’s assessment of overall health” to supplement the SSA tables. Men deemed to be in the best quartile of health have a 50% greater life expectancy, while life expectancy is reduced by 50% for men considered to be in the worst quartile. Men in the second and third quartile would have the life expectancy assigned by the tables. It is worth noting that the uniformly accepted American Society of Anesthesiologists (ASA) score for patients undergoing surgery similarly relies on a subjective assessment of overall health.

    Consider a 60-year-old man as an example. Actuarial tables predict an additional 21.48 years of life expectancy. Those determined to be in the best quartile of health would have 50% more years (21.48+10.74=32.22 years) and would be expected to live to age 92.22, while those in the worst quartile of health would have a 50% reduction (21.48–10.74=10.74 years) and would be expected to live to 70.74 years. Thus, 60-year-old men in the lowest projected quartile have a 10- to 11-year life expectancy, the middle two quartiles have a 21- to 22-year life expectancy, and the highest quartile has a 32 year life expectancy.

    Related: Urolithiasis mortality rate high in lower income nations

    Interestingly, calculators from large insurance companies incorporate a range of additional factors not considered during most physician visits. An online lifespan calculator from Northwestern Mutual incorporates compliance with medical care, stress, diet and exercise, and driving history. In this model, binge drinking or a driving while intoxicated conviction in the past 5 years reduces life expectancy by 5-10 years. Divorce has also shown to have a detrimental impact on male survival in longevity studies. Thus, as we know intuitively, what is listed in the medical chart doesn’t always tell the whole story.

    Like many tools, risk calculators offer additional objective data to improve decision-making, but are used optimally when incorporated with other available information. In the end, the clinician’s “good judgment” is required to put together all of the pieces and offer reasonable options to each patient. Ultimately, being familiar with one or two scoring systems to use when treating more complex patients and to justify management in the medical record will likely be to your benefit.

     

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    Ariel Schulman, MD
    Dr. Schulman is a urologic oncology fellow at Duke Medical Center, Durham, NC.

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