Cardiovascular comorbidity and treatment regret in men with recurrent prostate cancer

OBJECTIVE To determine whether cardiovascular comorbidity is associated with increased treatment regret among men with recurrent prostate cancer. METHODS The study cohort comprised 795 men in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry who experienced biochemical recurrence at a median (interquartile range) of 5.5 (2.8-9.1) years after prostatectomy (n = 410), external beam radiation therapy (n = 237), brachytherapy (n = 124) or primary androgen deprivation therapy (n = 24). Multivariable logistic regression analysis was used to determine whether cardiovascular comorbidity was associated with treatment regret. Cardiovascular comorbidity, which included myocardial infarction, congestive heart failure, angina, diabetes, stroke or circulation problems, was defined using a validated two-question screening process after adjusting for sociodemographic and treatment factors and post-treatment bladder and bowel toxicity. RESULTS Of 795 men, 14.8% reported regret. Men with cardiovascular comorbidity were more likely to experience post-therapy bowel toxicity (P = 0.022). In the adjusted multivariable model, the factors associated with increased treatment regret were: cardiovascular comorbidity (adjusted odds ratio [AOR] = 1.52 [95% CI: 1.00-2.31], P = 0.048); younger age (AOR: 0.97 [95% CI 0.94-0.99] per year increase in age, P = 0.019); and bowel toxicity after treatment (AOR 1.58 [95% CI 1.03-2.43], P = 0.038). CONCLUSIONS Among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to experience treatment regret than men without cardiovascular comorbidity. These data provide a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.