Co-Morbidities and Survival of Men with Localized Prostate Cancer Treated with Surgery or Radiation Therapy

Fowler, Jackson E.; Terrell, Freddie L.; Renfroe, Land D.

doi:10.1097/00005392-199611000-00045

Cited by 27 publications

(36 citation statements)

References 6 publications

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“…In survival analyses, these men had a 70% probability of nonprostate cancer mortality at 10 years after treatment; this is commensurate with published estimates of long-term nonprostate mortality associated with Charlson scores !3. [16][17][18] In contrast, the risk of prostate cancer mortality was extremely low in our cohort over the period of follow-up (2 of 509 men; (<1%). This low mortality rate is consistent with those reported from large retrospective cohort studies of men with untreated, low-risk disease.…”

Section: Discussioncontrasting

confidence: 56%

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Daskivich

Chamie

Kwan

et al. 2010

Cancer

127

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BACKGROUND: Men with low-risk prostate cancer and significant comorbidity are susceptible to overtreatment. The authors sought to compare the impact of comorbidity and age on treatment choice in men with low-risk disease. METHODS: The authors sampled 509 men with low-risk prostate cancer diagnosed at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers between 1997 and 2004. Rates of aggressive treatment (radical prostatectomy, radiation therapy, brachytherapy) were determined among men of different ages and with different Charlson comorbidity scores. Multivariate modeling 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. CONCLUSIONS: 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. Cancer 2011;117:2058-66.

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Section: Discussioncontrasting

confidence: 56%

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Daskivich

Chamie

Kwan

et al. 2010

Cancer

127

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“…2,[18][19][20][21][22][23] This means that the observed differences in survival between patients with and without co-morbidity could not be (fully) explained by these variables. The negative influence of co-morbidity on survival might be owing to several mechanisms, such as the increased risk of death owing to the co-morbid condition itself.…”

Section: Discussionmentioning

confidence: 99%

Greater influence of age than co-morbidity on primary treatment and complications of prostate cancer patients: an in-depth population-based study

Houterman

Janssen‐Heijnen

Verheij

et al. 2006

Prostate Cancer Prostatic Dis

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We investigated the influence of age and co-morbidity on treatment, the occurrence of serious nonurological complications of treatment and prognosis for prostate cancer patients diagnosed and treated in community hospitals. Additional information from a random sample of 505 prostate cancer patients (aged 40 years or older) from the Eindhoven Cancer Registry diagnosed between 1995 and 1999 was collected. In all, 43% of the prostate cancer patients aged 40-69 years and 64% of those aged 70 or older suffered from one or more serious concomitant disease that barely affected primary treatment choice. However, compared to patients without co-morbidity, patients with cardiovascular diseases underwent radical prostatectomy less often (P ¼ 0.01). In all, 38% of the patients undergoing radical prostatectomy suffered from complications during the first year after diagnosis versus about 20% of those receiving radiotherapy. The number of complications did not seem to be affected by comorbidity. After adjustment for age, stage, grade, prostate-specific antigen level and treatment, the cumulative risk of death was almost two times higher for patients with two or more concomitant diseases than for patients without co-morbidity. After adjustment for age, prostate cancer patients with co-morbidity were not treated differently, did not suffer from more complications but had a worse prognosis, compared to those without co-morbidity.

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“…Men with prostate carcinoma were also more likely to die from other causes than prostate carcinoma when comorbidity was present. 12,15 Particular comorbid conditions may have a relatively greater impact on treatment decisions. The current results of a decreased likelihood of surgery or radiation treatment in the presence of other nonpros- tate neoplastic disease confirm earlier findings 6 and may reflect concerns about life expectancy or treatment complications.…”

Section: Discussionmentioning

confidence: 99%

Initial treatment for prostate carcinoma in relation to comorbidity and symptoms

Hall¹,

Satariano²,

Thompson³

et al. 2002

Cancer

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BACKGROUNDEvidence suggests the type of treatment received for prostate carcinoma is associated with comorbidity, but little information is available on associations with specific comorbid disease or symptoms. The authors examined the relations between treatment and comorbidity, specific comorbid disease, and symptoms.METHODSMedical records were abstracted for 1054 male members of the Kaiser Permanente medical care program diagnosed with prostate carcinoma from 1975 to 1987. Information was obtained on demographic characteristics, comorbid conditions, symptoms, tumor stage and grade, and treatment. Logistic regression was used to determine the significant predictors of treatment (radiation vs. nonaggressive treatment and surgery vs. nonaggressive treatment).RESULTSCompared to nonaggressive treatment, radiation treatment was less likely among men who had prior cancer (adjusted odds ratio [OR] 0.29, 95% confidence interval [CI] 0.09–0.90) or cerebrovascular disease (OR 0.33, 95% CI 0.13–0.83). There was a significant interaction between race and myocardial infarction (P = 0.02). Surgery, compared to nonaggressive treatment, was less common among men with a prior cancer (OR 0.21, 95% CI 0.07–0.63) or congestive heart failure (OR 0.29, 95% CI 0.09–0.90). Significant interactions were observed between race and myocardial infarction (P = 0.01), diabetes and dysuria or hematuria (P = 0.02), and para‐ or hemiplegia and urinary frequency or nocturia (P = 0.01).CONCLUSIONSSpecific symptoms and comorbidity appear to influence treatment for prostate carcinoma. More research is needed on treatment differences by race. Cancer 2002;95:2308–15. Published 2002 by the American Cancer Society.DOI 10.1002/cncr.10926

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Co-Morbidities and Survival of Men with Localized Prostate Cancer Treated with Surgery or Radiation Therapy

Cited by 27 publications

References 6 publications

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Overtreatment of men with low‐risk prostate cancer and significant comorbidity

Greater influence of age than co-morbidity on primary treatment and complications of prostate cancer patients: an in-depth population-based study

Initial treatment for prostate carcinoma in relation to comorbidity and symptoms

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