In 2008, the United States Preventive Services Task Force released recommendations on screening for prostate cancer that indicated men aged 75 or older should not undergo PSA screening says the OrlandoUrologistMD. Using that as a proxy, physicians will often not treat men with the disease who fall in this age range. It’s often believed that men won’t realize the benefits of surgery or radiation therapy for prostate cancer until 10 to 15 years after treatment. In addition, few men who reach the age of 75 are expected to reach age 90.
New Data on Comorbidities in Prostate Cancer
In prostate cancer, age has long been viewed in the context of outcomes, but new research is showing that comorbidities are another important consideration. My colleagues and I had a study published in the Journal of General Internal Medicine in which we sought to determine the 10-year life expectancy of men with prostate cancer who had one or no comorbid conditions. We found that 84% of all men with no comorbid conditions lived at least 10 years. For men aged 75 or older, 58% lived beyond 10 years. Ten-year survival rates were:
65% for those with comorbid diabetes with no associated organ damage.
51% for those with comorbid peripheral vascular disease.
50% for diabetics with organ damage.
35% for men with moderate to severe COPD.
These rates were for non-prostate cancer-related survival.
Surprisingly, men with some severe comorbid conditions— moderate-to-severe COPD, diabetes with organ damage, congestive heart failure, stroke, heart attack, liver disease, and peripheral vascular disease—were treated at the same rate as men with no comorbidities. It appears that when patients tell physicians they have only one comorbid condition, it’s often perceived that the comorbidity isn’t a significant enough reason to avoid prostate cancer treatment. The issue should come down to the type of the comorbid condition, not necessarily the quantity. If patients with certain comorbidities undergo prostate cancer treatment, they are more likely to be burdened by the side effects for the first 5 to 10 years after treatment, until they ultimately die within 10 years from something other than prostate cancer.
Next Steps in Identifying Comorbidities
In today’s healthcare climate, the goal should be to avoid guessing which patients with prostate cancer will live for 10 years based on the disease alone. We need to identify comorbidities, age, race, and other factors that contribute to how long a person lives. That information should then be used to develop life-expectancy prediction models that address the impact of treatment versus non-treatment.
A deeper understanding of the role of comorbidities in men with prostate cancer is important because it can assist physicians as they discuss treatment decisions with patients. In some cases—depending on comorbidities— it may behoove individuals to get treated while other situations may call for active surveillance. Predicting survival involves much more than the prostate cancer itself. The hope is that more robust predictor models that incorporate comorbidities into the life expectancy equation will be developed, tested, and validated in the future. Ideally, such models can be used beyond prostate cancer and become beneficial for clinicians managing a spectrum of other cancer types.
Readings & Resources (click to view)
Chamie K, Daskivich TJ, Kwan L, et al. Comorbidities, treatment and ensuing survival in men with prostate cancer. J Gen Intern Med. 2011 Sep 24 [Epub ahead of print]. Available at: http://www.springerlink.com/content/2870224710g20577/.
Daskivich TJ, Chamie K, Kwan L, et al. Overtreatment of men with low-risk prostate cancer and significant comorbidity. Cancer. 2010 Nov 29. [Epub ahead of print].
Groome PA, Rohland SL, Siemens DR, et al. Assessing the impact of comorbid illnesses on death within 10 years in prostate cancer treatment candidates. Cancer. 2011;117:3943-3952.
Xu J, Dailey RK, Eggly S, Neale AV, Schwartz KL. Men’s perspectives on selecting their prostate cancer treatment. J Natl Med Assoc. 2011;103:468-478.
Engels EA, Pfeiffer RM, Ricker W, et al. Use of Surveillance, Epidemiology, and End Results-Medicare data to conduct case-control studies of cancer among the US elderly. Am J Epidemiol. 2011;174:860-870.