Increasing Comorbidity Weakens Aggressive Prostate Cancer Tx Benefit

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Increasing Comorbidity Weakens Aggressive Prostate Cancer Tx Benefit
Increasing Comorbidity Weakens Aggressive Prostate Cancer Tx Benefit

(HealthDay News) -- For men with early-stage prostate cancer, the cancer-specific survival benefit associated with aggressive prostate cancer treatment is reduced with increasing comorbidity, according to a study published online May 13 in Cancer.

Timothy J. Daskivich, MD, from the University of California in Los Angeles, and colleagues compared the effectiveness of aggressive versus nonaggressive treatment for reducing cancer-specific mortality in a cohort of 140,553 men aged ≥66 years with early-stage prostate cancer. Data for participants, diagnosed between 1991 and 2007, were extracted from the Surveillance, Epidemiology, and End Results-Medicare database.

The researchers found that, among men with Charlson scores of 0, 1, and 2, but not among those with scores of ≥3, aggressive treatment correlated with a reduced risk of cancer-specific mortality (subhazard ratio for Charlson score ≥3, 0.85; 95% confidence interval, 0.62 to 1.18) in propensity-adjusted competing-risks regression analysis. 

RELATED: Male Reproductive Cancers Resource Center

For men with Charlson scores of 0, 1, 2, and ≥3, the absolute reduction in 15-year cancer-specific mortality between men who received aggressive versus nonaggressive treatment was 6.1%, 4.3%, 3.9%, and 0.9%, respectively. 

Aggressive treatment correlated with a lower risk of cancer-specific mortality among men who had well-differentiated and moderately-differentiated tumors with Charlson scores of 0, 1, and 2, but not ≥3 (subhazard ratio for Charlson score ≥3, 1.14; 95 percent confidence interval, 0.70 to 1.89). 

When considering only well- and moderately-differentiated tumors, the absolute reduction in 15-year cancer-specific mortality was 3.8%, 3.0%, 1.9%, and −0.5% for men with Charlson scores of 0, 1, 2, and ≥3, respectively.

"The cancer-specific survival benefit from aggressive treatment for early-stage prostate cancer diminishes with increasing comorbidity at diagnosis," the researchers wrote.

One author is a cofounder of Wiser Care.

Reference

  1. Daskivich TJ, Lai J, Dick AW, et al. Comparative effectiveness of aggressive versus nonaggressive treatment among men with early-stage prostate cancer and differing comorbid disease burdens at diagnosis. Cancer. 2014;doi:10.1002/cncr.28757.

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