Dr. Whang comments:  This study states what most urologists already know: that prostate cancer is slow growing and many patients will die of something other than prostate cancer.  If a patient has many cormorbid diseases, it is better to choose less aggressive treatment including active surveillance and HIFU rather than radical surgery.

Comparative effectiveness of aggressive versus nonaggressive treatment among men with early-stage prostate cancer and differing comorbid disease burdens at diagnosis

1. Timothy J. Daskivich MD^1,*,
2. Julie Lai MPH²,
3. Andrew W. Dick PhD²,
4. Claude M. Setodji PhD²,
5. Janet M. Hanley MS²,
6. Mark S. Litwin MD, MPH^1,2,3,
7. Christopher Saigal MD, MPH^1,2 and
8. the Urologic Diseases in America Project

Article first published online: 13 MAY 2014

This study sought to compare the effectiveness of aggressive versus nonaggressive treatment in reducing cancer-specific mortality for older men with early-stage prostate cancer across differing comorbid disease burdens at diagnosis.

METHODS

In total, the authors sampled 140,553 men aged ≥66 years with early-stage prostate cancer who were diagnosed between 1991 and 2007 from the Surveillance, Epidemiology, and End Results-Medicare database. Propensity-adjusted competing-risks regression analysis was used to compare the risk of cancer-specific mortality between men who received aggressive versus nonaggressive treatment among comorbidity subgroups.

RESULTS

In propensity-adjusted competing-risks regression analysis, aggressive treatment was associated with a significantly lower risk of cancer-specific mortality among men who had Charlson scores of 0, 1, and 2 but not among men who had Charlson scores ≥3 (subhazard ratio, 0.85; 95% confidence interval, 0.62-1.18). The absolute reduction in 15-year cancer-specific mortality between men who received aggressive versus nonaggressive treatment was 6.1%, 4.3%, 3.9%, and 0.9% for men with Charlson scores of 0, 1, 2, and ≥3, respectively. Among men who had well-differentiated and moderately-differentiated tumors, aggressive treatment again was associated with a lower risk of cancer-specific mortality for those who had Charlson scores of 0, 1, and 2 but not for those who had Charlson scores ≥3 (subhazard ratio, 1.14; 95% confidence interval, 0.70-1.89). The absolute reduction in 15-year cancer-specific mortality between men who received aggressive versus nonaggressive treatment was 3.8%, 3%, 1.9%, and −0.5% for men with Charlson scores of 0, 1, 2, and ≥3, respectively.

CONCLUSIONS

The cancer-specific survival benefit from aggressive treatment for early-stage prostate cancer diminishes with increasing comorbidity at diagnosis. Men with Charlson scores ≥3 garner no survival benefit from aggressive treatment. Cancer 2014. © 2014 American Cancer Society.