Comorbidities should play a role in prostate cancer treatment decisions
MedWire News: The level of aggressiveness of treatment for men with low-risk prostate cancer should be determined not only by their age, but also by their comorbidity status, suggest US researchers.
In the same way that being aged over 75 years is a contraindication for aggressive prostate cancer treatment due to reduced life expectancy, study results show that having significant comorbidities should also represent a "cutoff" for aggressive therapy such as radical prostatectomy.
"We believe that the safest way for clinicians to apply comorbidity to treatment decision-making for prostate cancer is to identify patients at the highest risk for nonprostate cancer mortality and at the lowest risk for prostate cancer mortality - such as those with Charlson [comorbidity] scores of 3 or more - and to consider active surveillance or watchful waiting over aggressive treatment for these men," say Timoth Daskivich (University of California, Los Angeles) and colleagues.
The findings emerge from a study of 509 men diagnosed with low-risk (clinical stage T2a or less, serum prostate-specific antigen levels of 10 ng/ml or less, and Gleason score of 6 or less) prostate cancer.
The researchers assessed the pattern of aggressive treatment (surgery, radiotherapy, brachytherapy), and what influence age and comorbidity had on treatment choice.
The men were divided according to Charlson comorbidity score (0, 1, 2, and 3 or higher), and the mean age of the cohort was 66 years.
After a mean follow-up of 6.6 years, a total of 103 men had died, but only two of these deaths were from prostate cancer.
Analysis showed that despite a decline in the aggressiveness of treatment with increasing Charlson score, 54% of men with the highest score were treated aggressively.
In contrast, just 16% of men aged 75 years and above received aggressive therapy. There was a clear decline in treatment aggressiveness with increasing age, with a respective 84%, 79%, 57%, and 16% of men aged 55 years or less, 56-65 years, 66-75 years and 75 years and older treated in this way.
Indeed, multivariate analysis revealed that compared with being aged 55 years or younger, being aged 75 years or older increased the likelihood of being treated nonaggressively 12-fold, whereas a Charlson score of 3 or higher increased this chance by only two fold.
"We conclude that the aggressive treatment of men who have Charlson scores 3 or higher clearly represents overtreatment," write Daskivich et al in the journal Cancer.
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By Sarah Guy