Comorbidity status should inform prostatectomy choice
MedWire News: The greater the number of perioperative comorbidities a man with prostate cancer has, the higher his risk for dying from causes other than prostate cancer after being treated with radical prostatectomy (RP), say US researchers.
The finding should alert physicians to consider comorbidity status when selecting the most appropriate treatment for prostate cancer, they write in the journal Urology.
"In light of the risk for post-treatment morbidity and the possibility of over-treatment, proper patient selection for RP is essential to minimize unnecessary patient morbidity and to manage healthcare costs," say Thomas Guzzo, from The Hospital of the University of Pennsylvania in Philadelphia, and colleagues.
The group evaluated the association between the Charlston Comorbidity Index (CCI) and death from causes other than prostate cancer in a cohort of 14,052 men treated with RP for clinically localized prostate cancer.
The CCI covers 19 conditions including heart disease, liver disease, and diabetes, which are scored based on their severity. Participants in the current study were stratified into three groups based on having a CCI score of 0 (n=12,117), 1 (n=1736), or 2 or more (n=199).
After a median follow-up of 7.6 years, 849 (6%) men died: 250 (29%) from prostate cancer, and 599 (71%) from other causes.
The rate of death from causes other than prostate cancer (after adjustment for age) significantly increased with increasing CCI score, report Guzzo et al, rising from 5.2 deaths per 1000 person-years for a score of 0 to 11.4 deaths per 1000 person-years for a CCI score of 2 or higher.
Conversely, the rate of death from prostate cancer decreased with increasing CCI score, remarks the team.
Furthermore, men in the highest CCI score group were twice as likely as men with lower scores to die from non-prostate cancer-specific causes (hazard ratio [HR]=2.18), and adjusting this result for known survival predictors (Gleason score, age, etc) made no significant difference (HR=2.09).
The overall estimated probability of age-adjusted, non-prostate cancer-specific survival among men with the highest CCI scores at 5, 10, and 15 years from RP, was 96.6%, 88.2%, and 74.9%, respectively, Guzzo and colleagues note.
"Our results highlight the importance of consideration of comorbid illnesses in proper patient selection for RP," they conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Sarah Guy