Comorbidities, Treatment and Ensuing Survival in Men with Prostate Cancer

Comorbidity is poorly integrated into prostate cancer decision making. We sought to characterize treatment type and subsequent survival for men with no more than a single comorbid condition. We conducted a retrospective study of 1,031 veterans with non-metastatic prostate cancer diagnosed in 1997-2004 at the Greater Los Angeles and Long Beach Veterans Affairs Medical Centers and followed until 2010. We used multivariate analyses to determine probabilities and relative risks of undergoing treatment for each health state and competing-risks regression analyses to model non-prostate cancer mortality. Compared with subjects without any comorbid conditions, only men with moderate-severe chronic obstructive pulmonary disease were less likely to receive definitive treatment for their prostate cancer (RR 0.74; 95% CI 0.44-0.99). Men with all other individual comorbidities were equally likely as men without comorbidity to receive definitive treatment. Compared with men without any comorbidities, a higher hazard rate for non-prostate cancer mortality was identified among men with diabetes without end-organ damage (HR 2.32; 95% CI 1.32-4.08), peripheral vascular disease (HR 2.77; 95% CI 1.14-6.73), moderate-severe chronic obstructive pulmonary disease (HR 5.46; 95% CI 2.68-11.12), diabetes with end-organ damage (HR 4.27; 95% CI 1.64-11.10), those in need of a mobility device (HR 3.29; 95% CI 1.87-5.80), and men with history of alcoholism (HR 1.77; 95% CI 1.07-2.93). Men with comorbid conditions and health states that portend poor prognoses are nonetheless aggressively treated for their prostate cancer. Advancing age modulates this effect.