Comorbidity tied to prostate cancer upgrading, up staging

(HealthDay)—Comorbidity burden is strongly and independently associated with pathological upgrading/up staging in men with clinically low-risk prostate cancer, according to a study published in the April issue of The Journal of Urology.

Matthew J. Maurice, M.D., from the Cleveland Clinic, and colleagues used the National Cancer Data Base to identify 29,447 cases of low-risk prostate cancer (Gleason score ≤6, clinical stage T1/T2a, prostate-specific antigen [PSA] <10 ng/mL) managed with prostatectomy from 2010 to 2011. The association between Charlson comorbidity score and upgrading (Gleason score >6) or up staging (T3-T4/N1) was assessed.

The researchers found that 449 men (1.5 percent ) had Charlson scores greater than 1, but at prostatectomy 44 percent of cases were upgraded/up staged. There was a significant association between upgrading/up staging and Charlson score greater than 1, age 70 years or greater, nonwhite race, higher prostate-specific antigen (PSA), and higher percentage of cores involved with disease in multivariate analysis. With further adjustment for age, race, PSA and core involvement, Charlson score remained a significant predictor of upgrading/up staging for younger white men.

"This finding may help improve disease risk assessment and clinical decision making in men with comorbidities considering active surveillance," the authors write.