Age and co-morbidity as risk factors for over-treatment of low-risk prostate cancer

In recent years, it has become increasingly well understood that patients diagnosed with low-risk prostate cancer are potentially susceptible to over-treatment. This is particularly the case among men who have significant degrees of co-morbidity and men greater than 75 years of age who have a life expectancy of < 15 years.

Daskivich et al. have investigated the impact of co-morbidity and age on treatment choice by using data from a sample of 509 men with low-risk prostate cancer diagnosed at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers between 1997 and 2004. They set out to determine rates of aggressive treatment (using radical prostatectomy, radiation therapy, and brachytherapy) among men with varied ages and varied Charlson comorbidity scores.

Their key findings are as follows:

  • 30/56 patients with Charlson scores ≥ 3 (54 percent) were treated aggressively.
  • 7/44 patients aged > 75 years at diagnosis (16 percent) were treated aggressively.
  • A Charlson score ≥ 3 (relative risk = 2.0) was a much stronger predictor of aggressive treatment than age > 75 years  (relative risk, 12.0).
  • Men with Charlson scores ≥ 3 had an 8-fold increased risk (hazard ratio [HR] = 8.4) and a 70 percent probability of other-cause mortality at 10 years.
  • Men aged >75 years had a 5-fold increased risk (HR = 4.9) and a 24 percent probability of other-cause mortality.

The authors conclude that, “Men with significant comorbidity often were 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.”

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