Comorbid Diseases Lessen Survival Benefit of Aggressive PCa Therapy

Surgery or radiotherapy confers an absolute reduction in 15-year cancer-specific mortality.
Surgery or radiotherapy confers an absolute reduction in 15-year cancer-specific mortality.

ORLANDO—Aggressive treatment of early-stage prostate cancer (PCa) confers no survival benefit in men with Charlson scores of 3 or higher, researchers reported at the American Urological Association 2014 annual meeting. These patients should pursue conservative management of low- and intermediate-risk tumors.

Timothy J. Daskivich, MD, of the University of California Los Angeles, and colleagues analyzed data from 140,553 men aged 66 years or older with clinically localized PCa diagnosed from 1991–2007.

In a propensity-adjusted competing-risks analysis, aggressive treatment (radical prostatectomy or  radiotherapy within 1 year after diagnosis) was associated with a significantly reduced risk of cancer-specific mortality (CCM) in men with Charlson scores of 0, 1, and 2, but not in men with scores of 3 or higher.

The absolute reduction in 15-year CCM between patients treated aggressively and non-aggressively was 6.1%, 4.3%, 3.9%, and 0.9% for those with Charlson scores of 0, 1, 2, and 3 or more, respectively. Non-aggressive treatment was defined as watchful waiting, active surveillance, or immediate or delayed androgen deprivation therapy.

Study findings were recently published online ahead of print in Cancer, where the authors wrote: “Our study provides evidence that the cancer-specific survival benefit of aggressive treatment wanes with increasing comorbidity burden at diagnosis.”

The study demonstrated that the risk of other-cause mortality far outweighs the absolute risk reduction associated with aggressive versus non-aggressive treatment in older men with a high burden of comorbid disease. 

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