GENERAL ICD- C61: Prostate cancer Page 2 of 18 ICD- C61: Malignant neoplasm of prostate Period of diagnosis % Relative survival N=46,

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1 Munich Cancer Registry Incidence and Mortality Selection Matrix Homepage Deutsch ICD- C61: Prostate cancer Survival Year of diagnosis Patients 7,45 49,513 Diseases 7,45 49,514 Cases evaluated 6,621 4,8 Creation date 8/22/217 Export date 8/16/217 Population (males) 2.38 m BERLIN GERMANY BAVARIA MUNICH Munich Cancer Registry at Munich Cancer Center Marchioninistr. 15 Munich, Germany E-ICD--C61-Prostate-cancersurvival.pdf

2 GENERAL ICD- C61: Prostate cancer Page 2 of 18 ICD- C61: Malignant neoplasm of prostate Period of diagnosis % Relative survival N=46, Figure 1a. Relative survival of patients with prostate cancer by period of diagnosis. Included in the evaluation are 46,592 cases diagnosed between 1988 and 215. The presented survival curves are derived from clinical records with valid follow-up informations, which means that death certificate cases (DCO) cases are omitted from the analysis. With this one restriction, the MCR has provided populationbased statistics since 1998, collecting data on all cancer cases in the region of southern Bavaria. Historical data of previous time periods can be heavily selected, therefore, univariate survival comparisons of the presented time periods must be carefully considered. Nonetheless, all calculable survival curves are depicted to facilitate the comparison of long time follow-up analyses of relative survival between particular cancers. Period of diagnosis n=6,613 n=18,633 n=21,346 obs. % rel. % obs. % rel. % obs. % rel. % Table 1b. Observed (obs.) and relative (rel.) survival of patients with prostate cancer by period of diagnosis for period (N=46,592). Period of diagnosis n=6, % n=18,633 4.% 27+ n=21, %

3 GENERAL ICD- C61: Prostate cancer Page 3 of 18 ICD- C61: Malignant neoplasm of prostate Year of diagnosis % Relative survival N=39,979 1 Year of diagnosis 1998 n=1, % n=1, % 2 n=1, % 21 n=1, % 22 n=2, % 23 n=2, % 24 n=2,68 6.7% 25 n=2,62 6.6% 26 n=2,52 6.3% 27 n=2, % 28 n=2,68 6.7% n=2, % 2 n=2, % 211 n=2, % 212 n=2, % 213 n=2, % 214 n=2, % 215 n=1,196 3.% SEER n=585,397 Figure 1c. Relative survival of patients with prostate cancer by year of diagnosis. Included in the evaluation are 39,979 cases diagnosed between 1998 and 215. The survival results of the SEER program (Surveillance, Epidemiology, and End Results) of the American National Cancer Institute (NCI) are summarized as the period of diagnosis from 2 to 214, and are represented by colored diamonds in order to facilitate comparisons between MCR and SEER. Year of diagnosis n=1,255 n=1,266 n=1,395 n=1,483 n=2,688 n=2,726 n=2,68 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. %

4 GENERAL ICD- C61: Prostate cancer Page 4 of 18 Year of diagnosis cont'd n=2,62 n=2,52 n=2,964 n=2,68 n=2,448 n=2,372 n=2,558 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % Year of diagnosis cont'd n=2,638 n=2,295 n=2,195 n=1,196 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % Table 1d. Observed (obs.) and relative (rel.) survival of patients with prostate cancer by year of diagnosis for period (N=39,979).

5 GENERAL ICD- C61: Prostate cancer Page 5 of 18 ICD- C61: Malignant neoplasm of prostate Total cohort % Survival N=39,979 N= Observed Expected Relative Figure 2a. Observed, expected and relative survival of the total cohort with prostate cancer. Included in the evaluation are 39,979 cases diagnosed between 1998 and 215. Group Total cohort n=39,979 obs. % rel. % Table 2b. Observed (obs.) and relative (rel.) survival of the total cohort with prostate cancer for period (N=39,979). Group Total cohort n=39,979.%

6 GENERAL ICD- C61: Prostate cancer Page 6 of 18 ICD- C61: Malignant neoplasm of prostate Age category % Observed survival N=46, Figure 3a. Observed survival of patients with prostate cancer by age category. Included in the evaluation are 46,592 cases diagnosed between 1988 and 215. Age category -59 yrs n=6,4 13.8% 6-69 yrs n=18, % 7-79 yrs n=16, % 8+ yrs n=4,829.4% ICD- C61: Malignant neoplasm of prostate Age category % Relative survival N=46, Age category -59 yrs n=6,4 13.8% 6-69 yrs n=18, % 7-79 yrs n=16, % 7 8+ yrs n=4,829.4% Figure 3b. Relative survival of patients with prostate cancer by age category. Included in the evaluation are 46,592 cases diagnosed between 1988 and 215.

7 GENERAL ICD- C61: Prostate cancer Page 7 of 18 Age category -59 yrs 6-69 yrs 7-79 yrs 8+ yrs n=6,4 n=18,449 n=16,94 n=4,829 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % Table 3c. Observed (obs.) and relative (rel.) survival of patients with prostate cancer by age category for period (N=46,592).

8 GENERAL ICD- C61: Prostate cancer Page 8 of 18 ICD- C61: Malignant neoplasm of prostate TNM staging % Relative survival N=38,357 1 TNM staging T1 n=6, % T2 n=18, % T3 n=9, % T4 n=1,73 4.4% N n=23, % N+ n=2, % NX n=6, % M1 n=2,92 7.6% NA/NOS n=8, % Figure 4a. Relative survival of patients with prostate cancer by TNM staging. For 38,482 of 46,592 cases diagnosed between 1988 and 215 valid data could be obtained for this item. For a total of 38,357 cases an evaluable classification was established. The accumulated percentage exceeds the % value because patients are potientially considered in more than one subgroup. The grey line represents the subgroup of 8,235 patients with missing values regarding TNM staging (17.7 % of 46,592 patients, the percent values of all other categories are related to n=38,357). TNM staging T1 T2 T3 T4 N N+ NX n=6,438 n=18,612 n=9,988 n=1,73 n=23,786 n=2,978 n=6,765 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. %

9 GENERAL ICD- C61: Prostate cancer Page 9 of 18 TNM staging cont'd M1 NA/NOS n=2,92 n=8,235 obs. % rel. % obs. % rel. % Table 4b. Observed (obs.) and relative (rel.) survival of patients with prostate cancer by TNM staging for period (N=38,357).

10 GENERAL ICD- C61: Prostate cancer Page of 18 ICD- C61: Malignant neoplasm of prostate TNM staging % Relative survival N=32,594 1 TNM staging T1 n=5, % T2 n=16, % T3 n=7, % T4 n=1, % N n=2, % N+ n=2,38 7.3% NX n=5, % M1 n=2,47 7.4% NA/NOS n=7, % Figure 4c. Relative survival of patients with prostate cancer by TNM staging. For 32,77 of 39,979 cases diagnosed between 1998 and 215 valid data could be obtained for this item. For a total of 32,594 cases an evaluable classification was established. The accumulated percentage exceeds the % value because patients are potientially considered in more than one subgroup. The grey line represents the subgroup of 7,385 patients with missing values regarding TNM staging (18.5 % of 39,979 patients, the percent values of all other categories are related to n=32,594). TNM staging T1 T2 T3 T4 N N+ NX n=5,46 n=16,743 n=7,915 n=1,116 n=2,486 n=2,38 n=5,18 obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. % obs. % rel. %

11 GENERAL ICD- C61: Prostate cancer Page 11 of 18 TNM staging cont'd M1 NA/NOS n=2,47 n=7,385 obs. % rel. % obs. % rel. % Table 4d. Observed (obs.) and relative (rel.) survival of patients with prostate cancer by TNM staging for period (N=32,594).

12 GENERAL ICD- C61: Prostate cancer Page 12 of 18 ICD- C61: Malignant neoplasm of prostate Extent of disease % Conditional relative 5 year survival N=38, Extent of disease Local n=33, % Regional n=2, % Distant n=2,92 7.6% 7 NA/NOS n=8, % Time since diagnosis (years) Figure 4e. Conditional relative 5-year survival of patients with prostate cancer by extent of disease. For 38,482 of 46,592 cases diagnosed between 1988 and 215 valid data could be obtained for this item. For a total of 38,313 cases an evaluable classification was established. The grey line represents the subgroup of 8,279 patients with missing values regarding extent of disease (17.8 % of 46,592 patients, the percent values of all other categories are related to n=38,313). Extent of disease Local Regional Distant NA/NOS Cond. Cond. Cond. Cond. surv. % surv. % surv. % surv. % n 5 yrs n 5 yrs n 5 yrs n 5 yrs 33, , , , , , , , , , , , , , , , , , , , , ,8.8 1, , , , , , , , , , Table 4f. Conditional relative 5-year survival of patients with prostate cancer by extent of disease for period (N=38,313). Conditional relative survival rates refer to the relative survival probability, in this case for 5 years after cancer diagnosis, compared to the age- and sex-matched population (= %) under the condition of being alive for a certain time period (x-axis in Figure 4c). The results illustrate to what extent the cancer induced mortality of particular subgroups declines in the subsequent years after detection of the malignancy. For instance, according to the presented survival statistics, patients in the subgroup extent of disease= Local, who are alive at least 3 years after cancer diagnosis, the conditional relative 5-year survival rate is 1.6% (n=26,754).

13 PROGRESSION ICD- C61: Prostate cancer Page 13 of 18 % Time to first progression (TTP) N=37, Type of progression Any type (CI) Events=6,646 Any type (1-KM) Events=6,646 Local relapse (CI) Events=1,531 Local relapse (1-KM) Events=1,531 Lymph node (CI) Events=499 Lymph node (1-KM) Events=499 Distant metastasis (CI) Events=3,112 Distant metast. (1-KM) Events=3,112 NOS (CI) Events=2,431 NOS (1-KM) Events=2, Figure 5a. Time to first progression of 37,228 patients with prostate cancer diagnosed between 1998 and 215 (in solid cancers M only) estimated by cumulative incidence function (CI, solid line) accounting for death as competing risk and by inverse Kaplan-Meier estimate (1-KM, dashed line). The frequency of events may be underestimated due to underreporting. Type of progression Distant Any type (CI) Any type (1-KM) Local relapse (CI) Local relapse (1-KM) Lymph node (CI) Lymph node (1-KM) metastasis (CI) n=37,228 n=37,228 n=37,228 n=37,228 n=37,228 n=37,228 n=37,228 % % % % % % %

14 PROGRESSION ICD- C61: Prostate cancer Page 14 of 18 Type of progression Distant cont'd metast. (1- NOS (CI) NOS (1-KM) KM) n=37,228 n=37,228 n=37,228 % % % Table 5b. Time to first progression of patients with prostate cancer for period (N=37,228).

15 PROGRESSION ICD- C61: Prostate cancer Page 15 of 18 ICD- C61: Malignant neoplasm of prostate Progression type % Observed post-progression survival N=7, Figure 5c. Observed post-progression survival of 7,513 patients with prostate cancer diagnosed between 1998 and 215. These 7,513 patients with documented progression events during their course of disease represent 19. % of the totally 39,615 evaluated cases (incl. M1, n=2,387, 6. %). Patients with cancer relapse documented via death certificates only were excluded (n=1,52, 3.8 %). Multiple progression types on different sites are included in the evaluation even when not occuring synchronously. The NOS (not otherwise specified) class is included under the condition, that it is the one and only progression type during the course of disease. Medical record documentation often lacks the linguistic severity to distinguish between local relapse, regional lymph node metastasis and distant spread in solid cancers. Frequently, the statement not specified is the only information in registries regarding relapse of the disease. The category Any type denotes all cases who suffered from at least one relapse during the course of disease (incl. primary M1-status). Although, the real number of relapsed patients is likely to be much higher. The accumulated percentage of patients with local relapse or distant metastasis exceeds the % value because patients are potientially considered in more than one subgroup. Type of progression Any type Local relapse Lymph node Distant metastasis NOS n=7,513 n=1,654 n=558 n=4,213 n=2,433 % % % % % Table 5d. Observed post-progression survival of patients with prostate cancer for period (N=7,513). Type of progression Any type n=7,513.% Local relapse n=1, % Lymph node n= % Distant metastasis n=4, % NOS n=2, %

16 PROGRESSION ICD- C61: Prostate cancer Page 16 of 18 ICD- C61: Malignant neoplasm of prostate Type of Progression: Distant metastasis % Observed post-progression survival by period of progression date N=5, Figure 5e. Observed post-progression (distant metastasis) survival of 5,346 patients with prostate cancer diagnosed between 1988 and 215 by period of progression. Period of progression n=741 n=1,6 n=2,975 % % % Table 5f. Observed post-progression (distant metastasis) survival of patients with prostate cancer for period by period of progression (N=5,346). Period of progression n= % n=1,6.5% 27+ n=2, %

17 USAGE ICD- C61: Prostate cancer Page 17 of 18 Shortcuts MCR Munich Cancer Registry, Germany NCI National Cancer Institute, USA SEER Surveillance, Epidemiology, and End Results, USA UICC Union for International Cancer Control, Geneva DCO Death certificate only NA Not available NOS Not otherwise specified Death certificate provides the only notification to the registry. OS Overall/Observed survival Overall/Observed survival (Kaplan-Meier estimate) Date of entry: diagnosis Event: death from any cause RS Relative survival Survival compared to general population, ratio of observed to expected survival (Ederer II method), reflecting cancer specific survival AS Assembled survival Assembled chart of observed, expected, relative survival CS Conditional survival Survival probability under the condition of surviving a given period of time TTP Time to progression Time to first progression / relapse Date of entry: diagnosis Event: (progression/ relapse): first local-, lymph node recurrence, distant metastasis or unspecified progression 1-KM CI 1 minus Kaplan-Meier estimator ( inverse Kaplan-Meier estimator) Cumulative incidence Death as competing risk (according to Kalbfleisch und Prentice) PPS Post-progression survival Survival since first progression / relapse (Kaplan-Meier estimate) Date of entry (progression / relapse): first local-, lymph node recurrence, distant metastasis or unspecified progression Event: death from any cause Recommended Citation Munich Cancer Registry. Survival ICD- C61: Prostate cancer [Internet]. 217 [updated 217 Aug 22; cited 217 Oct 1]. Available from: E-ICD--C61- Prostate-cancer-survival.pdf Copyright The content of the public web site provided by the Munich Cancer Registry is available worldwide and free of charge. All documents are free to download, utilize, copy, print-out and distribute, providing that the MCR is referenced. Disclaimer The Munich Cancer Registry reserves the right to not be responsible for the topicality, correctness, completeness or quality of the information provided. Liability claims regarding damage caused by the use of any information provided, including any kind of information which is incomplete or incorrect, will therefore be rejected.

18 INDEX ICD- C61: Prostate cancer Page 18 of 18 Fig./Tbl. Index of figures and tables Page 1a Relative survival by period of diagnosis (chart) 2 1b Survival by period of diagnosis (table) 2 1c Relative survival by year of diagnosis (chart) 3 1d Survival by year of diagnosis (table) 3 2a Survival of total cohort (chart) 5 2b Survival of total cohort (table) 5 3a Observed survival by age category (chart) 6 3b Relative survival by age category (chart) 6 3c Survival by age category (table) 7 4a Relative survival by TNM staging (chart) 8 4b Survival by TNM staging (table) 8 4c Relative survival by TNM staging (chart) 4d Survival by TNM staging (table) 4e Conditional survival by extent of disease (chart) 12 4f Conditional survival by extent of disease (table) 12 5a Time to first progression (chart) 13 5b Time to first progression (table) 13 5c Observed post-progression survival (chart) 15 5d Observed post-progression survival (table) 15 5e Observed post-progression survival by period of progression (chart) 16 5f Observed post-progression survival by period of progression (table) 16