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.
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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.