437 OVERTREATMENT OF MEN WITH LOW-RISK PROSTATE CANCER AND SIGNIFICANT COMORBIDITY

Abstract

INTRODUCTION AND OBJECTIVES: Men with low-risk prostate cancer and significant comorbidity are susceptible to overtreatment. We sought to compare the impact of comorbidity and age on treatment choice in men with low-risk disease. METHODS: We sampled 509 men with low-risk prostate cancer diagnosed at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers in 1997–2004. We determined rates of aggressive treatment (radical prostatectomy, radiation therapy, brachytherapy) among men with different ages and Charlson comorbidity scores. We used multivariate modeling to determine the influence of each in predicting non-aggressive treatment. We used Cox proportional hazards analysis to compare risks of othercause mortality among Charlson and age groups. RESULTS: Men with Charlson scores 3 were treated aggressively in 30 of 56 cases (54%), while men 75 years at diagnosis were treated aggressively in 7 of 44 cases (16%). In multivariate analysis, age 75 was a much stronger predictor of non-aggressive treatment (RR12.0, 95%CI 5.4– 28.3) than Charlson 3 (RR2.0, 95%CI 1.3–2.9). In survival analysis, men with Charlson 3 had an eightfold increased risk (HR8.4, 95%CI 4.2–16.6) and 70% probability of other-cause mortality at 10 years, while age 75 was associated with a fivefold increased risk (HR4.9, 95%CI 1.7–13.8) and 24% probability of other-cause mortality. CONCLUSIONS: Men with significant comorbidity were often overtreated for low-risk prostate cancer. Like advanced age, significant comorbidity should be a strong relative contraindication to aggressive treatment in men with low-risk disease.