# Other-cause mortality

Source: https://onco.cc/terms/other-cause-mortality/  
OnCo record `other-cause-mortality` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Dying of something that is not the cancer. In prostate cancer most men do, which makes it the outcome that decides how much any treatment can possibly help. It is also where the inequality that survives equal cancer care shows up, and almost no cancer service measures it.

## Summary

Other-cause mortality is death from any cause other than the disease under study, counted as a competing risk: once a man has died of a heart attack he can no longer die of prostate cancer, so the two are not independent and cannot be estimated with an ordinary Kaplan-Meier curve. The correct handling is a cumulative incidence function with a Fine and Gray subdistribution hazard, which is what the prostate literature reports as a subdistribution hazard ratio. Prostate cancer has an unusually strong competing-risk structure: the disease is common, slow, and diagnosed at a median age at which other causes of death are already the majority, so other-cause mortality sets a ceiling on how much benefit any prostate cancer treatment can deliver.

It carries the equity finding, which is why it has an entry here. Dess and Spratt assembled individual patient data on men with clinical T1 to T4, N0 to N1, M0 prostate cancer from three cohorts with progressively tighter control of access to care: the Surveillance, Epidemiology, and End Results registry (296,273 men), five equal-access Veterans Affairs medical centres (3,972 men, all treated surgically) and four pooled National Cancer Institute randomised radiotherapy trials (5,854 men), with inverse probability weighting for demographic, cancer and treatment differences. Prostate cancer-specific mortality in Black men fell from an age-adjusted subdistribution hazard ratio of 1.30 in the registry to 1.09 after weighting, was not significantly different in the equal-access surgical cohort (0.85), and was significantly lower in the randomised trial cohort (0.81). Other-cause mortality stayed significantly higher in two of the three: 1.30 in the weighted registry cohort and 1.17 in the weighted trial cohort.

What that means operationally. Once treatment and access are equalised, the excess prostate cancer death largely disappears and the excess death from everything else does not. A prostate cancer service that measures only cancer-specific mortality has therefore made itself blind to the larger surviving gap, in a population it sees regularly for years and treats with androgen deprivation, a therapy that worsens metabolic and bone health. The caveats belong with the finding: these are United States cohorts with a United States access gradient, the analysis is retrospective despite the weighting, and it addresses mortality after diagnosis at a given stage rather than the higher incidence and younger age at presentation in Black men.

## Fields

- Kind: Term
- Last checked: 2026-09-25
- Also known as: death from other causes; competing mortality; non-cancer mortality; competing risk of death; other cause mortality
- Tags: gu; prostate-glossary

## Notes

- Why competing risks need their own arithmetic. Censoring a man who died of a heart attack as though he were simply lost to follow-up assumes he could still have died of prostate cancer later, which he could not. The cumulative incidence function and the subdistribution hazard ratio keep the competing deaths in the denominator, which is why prostate papers report subdistribution hazard ratios rather than plain hazard ratios for cancer-specific death.
- It is also the reason localised treatment trials disagree. SPCG-4, which recruited clinically detected disease, showed a substantial benefit from prostatectomy at 29 years; PIVOT, in a largely screen-detected population where competing mortality dominated, found no significant difference at 19.5 years. The treatment was similar; the competing risk was not.
- For an individual man, the practical version of this word is his own health apart from the cancer. It is the reason a guideline talks about life expectancy and comorbidity before it talks about grade group, and the reason watchful waiting exists as a plan distinct from active surveillance.

## Sources

- Dess et al., JAMA Oncology 2019: association of Black race with prostate cancer-specific and other-cause mortality: https://doi.org/10.1001/jamaoncol.2019.0826
- US Preventive Services Task Force, JAMA 2018: screening for prostate cancer, recommendation statement: https://doi.org/10.1001/jama.2018.3710

## Connected records

- ideas: [Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity](https://onco.cc/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/)
- key papers: [Association of Black race with prostate cancer-specific and other-cause mortality](https://onco.cc/key-papers/paper-dess-black-race-prostate-mortality-jama-oncol-2019/), [PIVOT: follow-up of prostatectomy versus observation for early prostate cancer](https://onco.cc/key-papers/paper-wilt-pivot-prostatectomy-observation-nejm-2017/), [SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up](https://onco.cc/key-papers/paper-bill-axelson-spcg-4-29-year-nejm-2018/), [SWOG 9346: intermittent versus continuous androgen deprivation in metastatic prostate cancer](https://onco.cc/key-papers/paper-hussain-swog-9346-intermittent-androgen-deprivation-nejm-2013/), [Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction](https://onco.cc/key-papers/paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021/), [USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)](https://onco.cc/key-papers/paper-uspstf-prostate-screening-jama-2018/)
- terms: [Androgen deprivation therapy (ADT)](https://onco.cc/terms/adt/), [Androgen deprivation therapy (ADT)](https://onco.cc/terms/androgen-deprivation-therapy/), [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Overtreatment](https://onco.cc/terms/overtreatment/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Screening](https://onco.cc/terms/screening/), [Treatment-induced bone loss](https://onco.cc/terms/treatment-induced-bone-loss/)
- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Metastatic hormone-sensitive prostate cancer](https://onco.cc/cancers/prostate-mhspc/), [Non-metastatic castration-resistant prostate cancer](https://onco.cc/cancers/prostate-nmcrpc/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Hormonal Therapy](https://onco.cc/fronts/hormonal/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)

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JSON: https://onco.cc/api/v1/entities/other-cause-mortality.json