Comorbidity and primary treatment for localized prostate cancer: data from CaPSURE.

PURPOSE: The optimal approach for treating localized prostate cancer remains controversial, leading to a multifactorial decision making process. We characterized the extent to which the presence and number of comorbidities affects treatment for localized prostate cancer. MATERIALS AND METHODS: Data were abstracted from a longitudinal observational database of men with prostate cancer. A total of 5,149 men diagnosed with localized prostate cancer between 1995 and 2001 were included in this analysis if they had been treated with RP, external beam radiation, brachytherapy, hormonal therapy or surveillance. Comorbidity was assessed through a patient reported checklist of conditions. Multinomial logistic regression was used to determine the OR of the likelihood of receiving each type of therapy. The number of comorbidities and specific comorbidities in patients receiving RP were compared with comorbidities in patients receiving other treatment. RESULTS: The adjusted OR showed a dose response between the number of comorbidities and an increasing probability of any nonRP treatment. In addition, heart disease, stroke or another urinary condition were found to be associated with treatment. CONCLUSIONS: Patient comorbidities affect decision making regarding treatment for localized prostate cancer. Urologists and other physicians treating this disease appear to evaluate patient comorbidities when selecting treatment options.

Impact of comorbidity on health-related quality of life in men undergoing radical prostatectomy: data from CaPSURE.

OBJECTIVES: Comorbidity is one of many factors that may affect health-related quality of life (HRQOL) in men with prostate cancer. We hypothesized that the number and type of comorbidities negatively affect HRQOL in men undergoing radical prostatectomy. METHODS: We reviewed HRQOL outcomes before and up to 2 years after radical prostatectomy for men with localized prostate cancer in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a longitudinal disease registry. This analysis focused on 856 men who completed a pretreatment survey and at least one posttreatment survey. HRQOL was assessed using the University of California, Los Angeles, Prostate Cancer Index (six subscales) and the Medical Outcomes Study 36-Item Short Form questionnaire (eight subscales and two summary scales). The associations between HRQOL and the number and type of comorbidities were analyzed using repeated measures during a 2-year follow-up period. RESULTS: Preoperatively, men with no comorbidities had greater HRQOL scores than did men with comorbidities for physical health and disease-specific measures, but not for mental health measures. Only sexual function and the physical component summary scores showed a significant interaction between the number of comorbidities and time (P < 0.01 and P = 0.03, respectively). Significant interactions with time were observed for other urinary conditions, gastrointestinal disease, heart disease, and hypertension on at least one HRQOL domain. CONCLUSIONS: Men with comorbidities had worse HRQOL scores than men without comorbidities, both before and after radical prostatectomy. However, with two exceptions, the scores declined at similar rates after surgery. Specific comorbidities also had an association with certain HRQOL domains. Therefore, during preoperative counseling, clinicians should consider a patient's number and type of comorbidities.