SAN DIEGO—Older men with non-metastatic prostate cancer (PCa) and who have multiple major comorbidities are at high risk of dying from other causes within 10 years of their cancer diagnosis, researchers reported at the American Urological Association annual meeting.
Timothy J. Daskivich, MD, of the University of California Los Angeles, and colleagues analyzed data from 3,183 men with non-metastatic PCa who participated in the Prostate Cancer Outcomes Study. The 14-year cumulative other-cause cause mortality rates for patients with no, one, two, or three or more comorbidities were 24%, 33%, 46%, and 57%, respectively. Among men with three or more comorbidities, those aged 65 and 75 years had a twofold and fourfold increased risk of other-cause mortality, respectively, compared with men aged 55 years.
Additionally, among men with three or more comorbidities, 10-year other-cause mortality rates were 26%, 40%, and 71% for those aged 60 and younger, 61-74, and 75 and older, respectively, at diagnosis.
Men with no or one comorbidity who were managed conservatively had a 2.4 times and 2.2 times increased cancer mortality risk compared with men who received aggressive treatment, but men with two or more comorbidities did not have a significant increase in PCa mortality.
The investigators measured comorbidities as a count of the presence of 12 medical conditions at PCa diagnosis: diabetes, stroke, myocardial infarction, ulcer, congestive heart failure, angina, liver disease, arthritis, hypertension, depression, inflammatory bowel disease, and chronic lung disease.
“We feel that these data suggest that older men with multiple major comorbidities should consider conservative over aggressive treatment for low- and intermediate-risk disease given their preponderance of other-cause mortality risk and their low risk of dying from prostate cancer,” Dr. Daskivich told listeners. “We also feel that these data show that younger men with multiple comorbidities still may wish to pursue aggressive treatment for low- and intermediate-risk disease given their superior longevity.”