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.
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.”