Comorbidities Increase Mortality from Causes Other than Prostate Cancer, Study Reports

Comorbidities Increase Mortality from Causes Other than Prostate Cancer, Study Reports

The presence of one or more additional diseases (comorbidity) does not affect the risk of dying from prostate cancer, regardless of treatment type, a Swedish observational study reports. However, high comorbidity in prostate cancer patients is linked with increased mortality from other causes.

The study, “Effect of Comorbidity on Prostate Cancer–Specific Mortality: A Prospective Observational Study,” was published in The Journal of Clinical Oncology.

“Comorbidities are medical disorders that coexist with, but are distinct from, the primary diagnosis,” authors explained. They are usually associated with worsening health outcomes.

While researchers have addressed comorbidity in prostate cancer patients, studies have reported conflicting results on its association with prostate cancer mortality.

Researchers at the Queen Mary University of London, England, and the Karolinska Institute in Stockholm, Sweden, and colleagues investigated the effect of comorbidities on prostate cancer-specific mortality after accounting for patient and tumor characteristics.

Treatment type was also taken into account in their analysis. These included radical prostatectomy (a surgical procedure for removing the prostate gland); radical radiotherapy (a non-surgical treatment using radiation); androgen deprivation therapy, and watchful waiting (a strategy that monitors prostate cancer that isn’t causing any symptoms and avoids treatment unless it becomes symptomatic).

The study included 118,543 prostate cancer patients from the Prostate Cancer Database in Sweden from 1998 to 2012. Patients were followed for a median of 8.3 years until they died, either from prostate cancer or from other causes. Comorbidity registers were retrieved from 10 years before, until the date of prostate cancer diagnosis.

An initial analysis that did not account for either patient and tumor characteristics or treatment type showed that comorbidities affected the risk of patients dying specifically due to prostate cancer and from other causes. Patients with the highest comorbidity score were two times more likely to die from prostate cancer, and five times more likely to die from any other cause.

But after accounting for patient (marital status, educational level) and tumor characteristics (PSA levels, tumor grade, and clinical stage) the team failed to detect any effect of comorbidity on prostate-cancer specific mortality. The effect was maintained, however, for mortality due to other causes.

The same lack of effect was observed when they further adjusted for each treatment type. The association to other-causes mortality remained unaltered, with the most striking effect observed in patients treated with radical prostatectomy. Patients with high comorbidity had a 4.42-fold increase in mortality from other causes, compared to those without comorbidities.

Overall, these results suggest “that comorbidity affects other-cause mortality but not prostate cancer-specific mortality, accounting for patient and tumor characteristics and treatment type,” the study concluded.

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One comment

  1. Stephen B. Strum, MD, FACP says:

    Here’s the problem with ALL of our health issues. We have specialists who either do not wish to see an illness as a manifestation of both genetic + epigenetic causes or who do not wish to “infringe” on the specialties of other specialists. What we have is a myopic view of the patient’s health that misses the interactions aka systems biology, that is inherent in all of life. Everything is interactive; that’s why whoever coined the term uni-verse (one story) was a person of vision or prescience. What is being called wholistic medicine or integrative medicine (see https://www.dukeintegrativemedicine.org/about/what-is-integrative-medicine/ ) is really missing the mark.

    Interactive medicine looks intensely into the systems that interact with the disease that is currently most threatening to the patient. What circumstances on a biological level has created this disease scenario? When physicians look at prostate cancer & see the interaction of prolonged glycation, abnormal fatty acids, high oxidized LDL, suboptimal Vit D, bone-derived growth factors that stimulate cancer growth in a vicious cycle of bone loss and cancer growth stimulation, and all the interplay with the above & cardiovascular disease, renal, neurological, musculoskeletal health etc, then publications such as the one by Rajan et al on:
    Effect of Comorbidity on Prostate Cancer–Specific Mortality: A Prospective Observational Study can focus on what matters most: the quality & quantity of the patient’s life, no matter what the presenting disease.

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