Comorbid Disease Burden is Independently Associated with Higher-Risk Disease at Prostatectomy in Patients Eligible for Active Surveillance

Comorbid medical conditions are highly prevalent among prostate cancer patients and may be associated with more aggressive disease. We sought to investigate the association between comorbidity burden and higher-risk disease among men eligible for active surveillance.

Using the National Cancer Data Base, we identified 29,447 cases of low-risk (Gleason score ≤6, cT1/T2a, prostate specific antigen 6) or up-staging (T3-T4/N1). The association between Charlson score and upgrading/up-staging was analyzed using multivariate logistic regression.

The study sample comprised 29,447 men, of which, 449 men (1. 5%) had Charlson scores >1. At prostatectomy, 44% of cases were upgraded/up-staged. On multivariate analysis, Charlson score >1, age >70 years, non-white race, higher PSA, and higher percentage of cores involved with disease were significantly associated with upgrading/up-staging. After further adjusting for age, race, PSA, and core involvement, Charslon score remained a significant predictor of upgrading/up-staging for younger white men. Specifically, white men 1 had 1. 3-fold higher odds of upgrading/up-staging than men with CCI ≤1 (OR 1. 31, 95%CI 1. 03-1. 67; p=0. 029).

Comorbidity burden is strongly and independently associated with pathological upgrading/up-staging in men with clinically low-risk prostate cancer. This finding may help improve disease risk assessment and clinical decision-making in comorbid men considering active surveillance.

The Journal of urology. 2015 Oct 28 [Epub ahead of print]

Matthew J Maurice, Hui Zhu, Jonathan E Kiechle, Simon P Kim, Robert Abouassaly

Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. , Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH. , Urology Institute, University Hospitals Case Medical Center, Cleveland, OH. , Urology Institute, University Hospitals Case Medical Center, Cleveland, OH. , Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.

PubMed

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