Prostate cancer (PCa) patients with major comorbidities should consider conservative management for low- and intermediate-risk cancer and aggressive treatment for high-risk disease, researchers concluded in a study published online ahead of print in Cancer.

A team led by Timothy Daskivich, MD, of the University of California Los Angeles David Geffen School of Medicine, sampled 1,482 men diagnosed with nonmetastatic PCa at two Veterans Affairs hospitals from 1998 to 2004. Among these patients, 516 (36%), 475 (33%), and 432 (30%) had low-, intermediate-, and high-risk disease, respectively.

Men with high-risk disease were less likely to undergo aggressive treatment than those in other risk strata, regardless of Charlson comorbidity score. In competing-risk analyses, aggressive treatment was not associated with a cancer-specific survival benefit in men with multiple comorbidities and low- and intermediate-risk disease, but there was a strong trend toward a survival advantage in such men with high-risk disease, according to the researchers.

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“Although it may seem rational to use conservative management in all men with multiple major comorbidities, our data argue for a more individualized approach to patient care,” the authors wrote. “We do not believe in rationing of care for men with multiple cormorbidities, but rather that care should be rational: that men should be treated only for disease that poses a real threat to their remaining years.”