High-Grade Prostate Cancer More Likely To Be Found in Sicker Men

New study shows that heavier comorbidity burdens increase the risk of Gleason 7 or higher tumors being found at biopsy.
New study shows that heavier comorbidity burdens increase the risk of Gleason 7 or higher tumors being found at biopsy.

SAN DIEGO—Multiple comorbidities at the time of a prostate cancer (PCa) diagnosis is associated with higher biopsy Gleason scores, independent of age, according to study findings presented at the American Urological Association 2016 annual meeting.

In a study of 1,482 men diagnosed with non-metastatic PCa from 1998 to 2004, Timothy J. Daskivich, MD, Assistant Professor at Cedars-Sinai Medical Center in Los Angeles, and colleagues found that those with 2 and 3 or more comorbidities (Charlson Comorbidity Index scores of 2 and 3+) had a significant 1.8 times greater odds of having a Gleason score of 7 or higher compared with men who had no comorbidities (Charlson score of 0), after adjusting for age, race, clinical stage, PSA level, mobility status, and smoking history.

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Specifically, men with Charlson scores of 2 had 1.6 times greater odds of having a Gleason score of 7 (vs. ≤ 6) and 2.8 times greater odds of having a Gleason score of 8–10 (vs. ≤ 6), compared with those with Charlson scores of 0. Men with Charlson scores of 3+ were at 3-fold increased odds of having Gleason 8–10 (vs. ≤ 6) tumors, compared with those with Charlson scores of 0.

“Our data suggest that men with heavier comorbid disease burdens are more likely to have higher-grade prostate cancers at the time of biopsy,” Dr. Daskivich told Renal & Urology News. Although it might seem reasonable to omit PCa screening in sicker men to avoid overdiagnosis of low-grade tumors, this approach may result in underdetection of high-grade cancers, he said.

“This is problematic since emerging evidence suggests that even men with life expectancies of less than 10 years may benefit from surgery or radiation for high-grade disease,” said Dr. Daskivich, who is Director of Health Services Research for the Department of Surgery at Cedars-Sinai. “The optimal approach involves screening these men but only treating those who need it, in order to maximize treatment benefit and minimize morbidity.”

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