Prostate cancer treatment and survival: evidence for men with prevalent comorbid conditions

Abstract

Background: The absence of evidence-based guidelines for prostate cancer treatment led the Institute of Medicine to include localized prostate cancer treatment among the 25 most important topics for comparative effectiveness research.

Objective: This study compared prostate cancer treatment and survival in men with and without prevalent comorbid conditions.

Research design: The sample comprised elderly men, aged 66 years and older, extracted from SEER-Medicare data, between 2004 and 2009 (N=73,563). Treatment and survival for men with at least 1 of 4 prevalent comorbid conditions were compared with men who did not have any of the 12 Charlson comorbid conditions. The sample was stratified by comorbid condition and low-risk, intermediate-risk, and high-risk disease.

Results: Over half of men received some form of cancer-directed treatment, irrespective of comorbid condition. Men who have congestive heart failure (CHF) or multiple comorbid conditions were less likely to be treated, whereas men with diabetes were more likely to be treated. With the exception of men with CHF, men with comorbid conditions and low-risk disease received no survival benefit from any type of treatment.

Conclusions: Most men received treatment, particularly radiation therapy, regardless of comorbid condition. The evidence suggests more caution should be used when treating men with low-risk disease and comorbid conditions as they are at risk for adverse events and additional medical costs, without a survival benefit.

Figure 1

Deaths from prostate cancer and other causes by comorbid condition within 3 years of prostate diagnosis, N=64,989 CHF=Congestive heart failure; COPD=Chronic Obstructive Pulmonary Disease; CVA=Cerebrovascular Disease; DM=Diabetes mellitus. 8574 patients with less than 3 year follow-up were excluded.