Background
Clinical guidelines recommend that men with low-risk prostate cancer and significant comorbidity should not be treated aggressively because they are more likely to die of other causes before they die from their prostate cancer and aggressive treatments have risks of side effects that adversely affect quality of life.
However, these men are still susceptible to overtreatment.
Given that aggressive treatment for low risk prostate cancer is also not recommended in older men with a life expectancy of less than 10 years, the authors sought to compare the impact of comorbidity and age on treatment choice in men with low-risk disease.
Aim
To compare the impact of comorbidity and age on treatment choice in men with low-risk disease.
Methods
509 men with low-risk prostate cancer diagnosed at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers between 1997 and 2004 were included in the study.
Rates of aggressive treatment (radical prostatectomy, radiation therapy, brachytherapy) were determined among men of different ages and with different Charlson comorbidity scores.
Multivariate modelling was used to determine the influence of both variables in predicting nonaggressive treatment, and Cox proportional hazards analysis was used to compare the risk of other-cause mortality among groups according to Charlson score and age.
Results
Men with Charlson scores ≥3 were treated aggressively in 54% of cases (30 of 56 men), while men aged >75 years at diagnosis were treated aggressively in 16% of cases (7 of 44 men).
In multivariate analysis, age >75 years was a much stronger predictor of nonaggressive treatment (relative risk, 12.0; 95% confidence interval [CI], 5.4-28.3) than a Charlson score ≥3 (relative risk, 2.0; 95% CI, 1.3-2.9). In survival analysis, men with Charlson scores ≥3 had an 8-fold increased risk (hazard ratio, 8.4; 95% CI, 4.2-16.6) and 70% probability of other-cause mortality at 10 years, whereas age >75 years was associated with a 5-fold increased risk (hazard ratio, 4.9; 95%CI, 1.7-13.8) and a 24% probability of other-cause mortality.
Conclusion
Men with significant comorbidity often were overtreated for low-risk prostate cancer. Like advanced age, significant comorbidity should be a strong relative contraindication to aggressive treatment in men with low-risk disease.
