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

Abstract

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.

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

“…4,5 One explanation is that physicians have difficulty accurately estimating the effect of competing mortality risks on life expectancy. [6][7][8] Several comorbidity measures have been developed based on claims data, 9,10 but these tools are most widely used in health services research. 11 The American Urological Association (AUA) treatment guideline suggests using life-table analyses to inform treatment decisions, 2 but these population-based estimates exclude health status and may not be readily applicable to predicting the life expectancy of an individual patient.…”

Image-Guided Radiotherapy Dose Escalation in Intermediate and High Risk Cancer Prostate Patients and Its Effect on Treatment Toxicity

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Metabolomic Imaging for Human Prostate Cancer Detection using MR Spectroscopy at 7-T

“…Using the current diagnostic pathways, an overdiagnosis of those low-risk tumors has been shown, leading to a high rate of overtreatment 53 . This is of relevance since prostatectomy as the main therapeutic intervention causes irreversible side effects such as erectile dysfunction, urinary incontinence and bowel disturbances, with a great impact on the patients' life quality 54,55,56 .…”