Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Urology
Published in: World Journal of Urology 4/2017

01-04-2017 | Original Article

Current impact of age and comorbidity assessment on prostate cancer treatment choice and over/undertreatment risk

Authors: Pierre Lunardi, Guillaume Ploussard, Pascale Grosclaude, Mathieu Roumiguié, Michel Soulié, Jean Baptiste Beauval, Bernard Malavaud

Published in: World Journal of Urology | Issue 4/2017

Login to get access

Abstract

Purpose

We evaluated the influence of age and comorbidity (Charlson score assessment) on localized prostate cancer therapeutic management and the risk of prostate cancer over- and under-treatment.

Methods

Among the 2571 prostate cancer cases diagnosed in 2011, a subset of 633 patients was randomly selected from the prospectively accrued cohort of the Regional Cancer Registry, among the 17 participating institutions. Treatment distributions were examined for patients at each individual prostate cancer risk, age and comorbidity level and analyzed by multivariate logistic regression analysis.

Results

Treatments with curative intent were observed less often when age increased (p < 0.001). We found no impact of the Charlson score on the selection of a curative treatment [HR 0.89, 95 % CI (0.70–1.15)]. A 20 % overtreatment rate was reported in low-risk prostate cancer patients. For younger patients (65–75 years) with high comorbidity score, a 14 % overtreatment rate was observed. Conversely, a 16 % undertreatment rate was reported in older patients >75 years without any significant comorbidity.

Conclusion

A better consideration of comorbidities could significantly reduce overtreatment in patients <75 year and promote curative treatment in aggressive prostate cancer for older patients without any significant comorbidity.
Literature
1.
2.
3.
Moyer VA, U.S.P.S.T. Force (2012) Screening for prostate cancer: US preventive services task force recommendation statement. Ann Intern Med 157(2):120–134CrossRefPubMed
4.
Andriole GL et al (2012) Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst 104(2):125–132CrossRefPubMedPubMedCentral
5.
Heidenreich A et al (2014) EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol 65(1):124–137CrossRefPubMed
6.
Gwede CK et al (2005) Treatment decision-making strategies and influences in patients with localized prostate carcinoma. Cancer 104(7):1381–1390CrossRefPubMed
7.
Davison BJ, So AI, Goldenberg SL (2007) Quality of life, sexual function and decisional regret at 1 year after surgical treatment for localized prostate cancer. BJU Int 100(4):780–785CrossRefPubMed
8.
Droz JP et al (2014) Management of prostate cancer in older patients: updated recommendations of a working group of the International Society of Geriatric Oncology. Lancet Oncol 15(9):e404–e414CrossRefPubMed
9.
Cooperberg MR, Broering JM, Carroll PR (2010) Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 28(7):1117–1123CrossRefPubMedPubMedCentral
10.
D’Amico AV et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRefPubMed
11.
Charlson ME et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMed
12.
Soulie M et al (2001) Competitive morbidity ant its impact on life expectancy: evaluation and inclusion in the therapeutic decision regarding localized prostatic cancer. Prog Urol 11(6):1195–1204PubMed
13.
14.
Daskivich TJ et al (2011) Comorbidity and competing risks for mortality in men with prostate cancer. Cancer 117(20):4642–4650CrossRefPubMed
15.
16.
Bratt O et al (2015) Undertreatment of men in their seventies with high-risk nonmetastatic prostate cancer. Eur Urol 68(1):53–58CrossRefPubMed
17.
Albertsen PC et al (1996) The impact of co-morbidity on life expectancy among men with localized prostate cancer. J Urol 156(1):127–132CrossRefPubMed
18.
O’Connor AM, Llewellyn-Thomas HA, Flood AB (2004) Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Aff (Millwood) Suppl Variation:VAR63-72
19.
Daskivich TJ et al (2014) Variation in treatment associated with life expectancy in a population-based cohort of men with early-stage prostate cancer. Cancer 120:3642CrossRefPubMedPubMedCentral
20.
Delpierre C et al (2013) Life expectancy estimates as a key factor in over-treatment: the case of prostate cancer. Cancer Epidemiol 37(4):462–468CrossRefPubMed
21.
Vulto AJ et al (2006) The influence of age and comorbidity on receiving radiotherapy as part of primary treatment for cancer in South Netherlands, 1995 to 2002. Cancer 106(12):2734–2742CrossRefPubMed
22.
Mohan R et al (2009) Patients’ survival expectations before localized prostate cancer treatment by treatment status. J Am Board Fam Med 22(3):247–256CrossRefPubMed
23.
Daskivich TJ et al (2011) Overtreatment of men with low-risk prostate cancer and significant comorbidity. Cancer 117(10):2058–2066CrossRefPubMed
24.
Payne HA, Gillatt DA (2007) Differences and commonalities in the management of locally advanced prostate cancer: results from a survey of oncologists and urologists in the UK. BJU Int 99(3):545–553CrossRefPubMed
25.
Sooriakumaran P et al (2014) Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 348:g1502CrossRefPubMedPubMedCentral
26.
Berglund A et al (2011) Comorbidity, treatment and mortality: a population based cohort study of prostate cancer in PCBaSe Sweden. J Urol 185(3):833–839CrossRefPubMed
27.
Loeb S, Berglund A, Stattin P (2013) Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol 190(5):1742–1749CrossRefPubMed
28.
Walz J et al (2008) Accuracy of life tables in predicting overall survival in patients after radical prostatectomy. BJU Int 102(1):33–38CrossRefPubMed
29.
Klotz L et al (2015) Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 33(3):272–277CrossRefPubMed
30.
Ploussard G et al (2014) Challenging treatment decision-making in older urologic cancer patients. World J Urol 32(2):299–308CrossRefPubMed
Metadata
Title
Current impact of age and comorbidity assessment on prostate cancer treatment choice and over/undertreatment risk
Authors
Pierre Lunardi
Guillaume Ploussard
Pascale Grosclaude
Mathieu Roumiguié
Michel Soulié
Jean Baptiste Beauval
Bernard Malavaud
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 4/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-016-1900-9

Other articles of this Issue 4/2017

World Journal of Urology 4/2017 Go to the issue

Original Article

Analysis of active surveillance uptake for low-risk localized prostate cancer in Canada: a Canadian multi-institutional study

Letter to the Editor

Ales Vidlar, Vladimir Student Jr., Jitka Vostalova, Emilie Fromentin, Marc Roller, Vilím Simanek, Vladimir Student: Cranberry fruit powder (Flowens™) improves lower urinary tract symptoms in men: a double-blind, randomized, placebo-controlled study. World Journal of Urology: March 2016, Volume 34, Issue 3, pp 419–424

Original Article

Genetic variants in RNA-induced silencing complex genes and prostate cancer

Topic Paper

The rationale and the role of lymph node dissection in renal cell carcinoma

Topic Paper

PET imaging for lymph node dissection in prostate cancer

Original Article

Can robot-assisted laparoscopic radical prostatectomy (RALP) be performed very soon after biopsy?