Patient comorbidity is associated with conservative treatment of localized prostate cancer

Abstract

Objective. The aim of this study was to investigate how prostate cancer treatment varies by level of comorbidity among men with localized prostate cancer. Materials and methods. A nationwide cohort study was conducted of all patients younger than 75 years of age with incident localized prostate cancer registered in the Danish Cancer Registry from 1 October 2003 to 31 December 2010. Number and percentages were tabulated, and the prevalence ratios were calculated of patients treated with radical prostatectomy or radiotherapy during the first year after prostate cancer diagnosis according to comorbidity level at the time of prostate cancer diagnosis. Results. The study included 9643 patients, of whom 79% (7576) had no comorbidity, 10% (979) had a Charlson comorbidity index score of 1, 8% (779) had a Charlson score of 2, and 3% (309) had a Charlson score of 3 or more. The cumulative 1 year incidences of prostatectomies were 41%, 23% and 13% among those with Charlson scores of 0, 1–2 and ≥3, respectively. This corresponded to 1 year prevalence ratios of 0.60 [95% confidence interval (CI) 0.54–0.67] and 0.33 (95% CI 0.25–0.44) for patients with Charlson scores of 1–2 and ≥3, respectively, compared with patients with Charlson 0. The cumulative 1 year incidence of radiotherapy did not differ much by Charlson score. The 1 year prevalence ratios of radiotherapy were 1.27 (95% CI, 1.12–1.45) and 1.10 (95% CI 0.94–1.28) for patients with Charlson scores of 1 and ≥2, respectively, compared with patients with Charlson 0. Conclusion. The results show that patients with comorbidity were treated less aggressively for their localized prostate cancer than patients without comorbidity.

Key Words:

• Comorbidity
• prevalence ratios
• prostatectomy
• prostatic neoplasms
• radiotherapy

Acknowledgements

This work has been supported by funding from the Aarhus University Research Foundation, The Danish Cancer Society, The Foundation for Scientific Research in Central Jutland, Agnes Niebuhr Anderssons Foundation, Frimodt Heineke Foundation and Kong Christian Den Tiendes Foundation. The contributors had no specific roles in the analysis, interpretation of the results or drafting of the manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.