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Did They Die Of Prostrate Cancer

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An audit of death certificates from Norway has found that one third of all deaths attributed to prostate cancer were actually caused by something else.

However, there was also an underreporting of prostate deaths in the study — wherein some men who were reported to have died of other causes were considered by the researchers to have actually died of prostate cancer.

Overall, the correlation between the registered (on death certificates) and observed (upon review by the investigators) prostate cancer deaths was 81%.

The study was published online August 11 in the Scandinavian Journal of Urology.

The overreporting of 32% was partially offset by a 23% rate of underreporting, but the “net result was a considerable over-registration of prostate cancer deaths,” say the authors, led by Sven Löffeler, MD, a urologist at the Vestfold Hospital Trust in Tonsberg, Norway.

Overreporting of prostate cancer deaths — particularly among elderly men — “may not be an exclusively Norwegian phenomenon and may affect prostate cancer mortality statistics in other countries,” they comment.

The authors say their investigation is important because “official cancer mortality statistics strongly influence the perception of different cancers.”

Dr Löffeler observed that the medical literature routinely reinforces such perceptions. “Virtually every article that is published on prostate cancer starts with something like, ‘Every year in the US so-and-so many men die of prostate cancer,’ suggesting that reducing this number is what we are aiming at,” he said. “But what if these numbers are unreliable?”

Study Details

“Our study is one of the very few that has studied an entire prostate cancer death population and their medical history in detail,” Dr Löffeler .

The investigators reviewed the records of all deceased men from 2009 to 2014 in Vestfold County, 1 of the 18 counties in Norway. Vestfold is small (only 230,000 residents) but is representative of the socioeconomics of Norway’s population.

The study’s review committee consisted of three urologists and one oncologist, all of whom treat patients with prostate cancer. They did a careful, three-part review of patient history, checking death certificates against medical records to determine the likelihood of a prostate cancer–related death.

The team identified 328 men who had prostate cancer as the immediate cause of death (part I of the death certificate) and 126 who had prostate cancer as another significant condition (part II of the death certificate).

There was an additional group of 310 men who died but did not have a diagnosis of prostate cancer on their death certificate; a crosscheck using the Norwegian Cancer Registry and the Norwegian Institute of Public Health revealed an earlier prostate cancer diagnosis.

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