Prostate cancer treatment regrets linked to comorbidity

By Lynda Williams

Men with cardiovascular (CV) disease are significantly more likely to regret their prostate cancer treatment choice than men without this comorbidity and have an increased risk for adverse effects, US researchers warn.

"This study highlights the growing importance of considering comorbidity when counselling patients about prostate cancer treatment options, and provides a rationale for men with [CV] comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer," say Paul Nguyen (Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts).

Noting that radiotherapy and surgery offer only a small benefit to men with a short life expectancy, the team says their study "suggests that patients with [CV] comorbidity should be alerted to their potential for an increased risk of post-treatment toxicity, as this may help to mitigate treatment regret if their cancer recurs."

Overall, 14.8% of 795 patients with biochemical recurrence included in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry reported treatment regret a median of 5.5 years after treatment. The patients had undergone prostatectomy (n=410), external beam radiation (n=237), brachytherapy (n=124), or androgen deprivation therapy (n=24).

Almost a third (30.6%) of the patients had CV disease, such as myocardial infarction, congestive heart failure, angina, diabetes, stroke, or circulation concerns. These patients were significantly more likely to experience bowel toxicity related to treatment than those without CV comorbidity (44.4 vs 35.8%).

CV comorbidity patients also had a nonsignificant increased risk for urinary problems compared with non-CV patients (45.7 vs 39.1%), but did not differ with regard to sexual function, the researchers report in BJU International.

In multivariate analysis, treatment regret was significantly predicted by CV comorbidity (odds ratio [OR]=1.52), and bowel toxicity after treatment (OR=1.58), after adjusting for confounders including race, treatment type, and toxicity.

Noting that younger age (OR=0.97 per year increase in age) also predicted regret, the researchers say these patients may regret choosing a conservative treatment that missed the opportunity of a cure.

They emphasize: "For younger patients, a prostate cancer recurrence may represent a major threat to longevity, and so the consequences of recurrence can be grave. Younger patients should, therefore, be given ample opportunity to carefully weigh their treatment options beforehand so that they feel fully informed and as less likely to regret their choice if cancer recurs."

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