The independent prognostic value of comorbidity among men aged < 75 years with localized prostate cancer: a population-based study

Objective To investigate which prognostic factors apply in patients with lo calized prostate cancer diagnosed after the introduction of prostate-specif ic antigen (PSA) testing, as comorbidity has significant prognostic value f or patients who were diagnosed with localized prostate cancer in the 1970s. Patients and methods Using the Eindhoven Cancer Registry, we assessed a pop ulation-based cohort of patients aged < 75 years with localized (T1-T3M0) p rostate cancer diagnosed between 1993 and 1995 in a defined area with 2 mil lion inhabitants in the southern Netherlands (n=894). After a mean followup of 2.9 years, overall survival was modelled by Cox regression analyses. Results Comorbidity was the most important prognostic factor, especially fo r those aged <70years; at 60 years old, patients with one concomitant disea se were twice as likely to die than those with no comorbidity (95% confiden ce interval, CI, 1.0-4.3), whereas the hazard ratio (HR) was 7.2 (3.1-16.6) for two or more diseases. This was not caused by a reduced use of curative treatment for these patients. At the age of 74 years, comorbidity was no l onger a significant prognostic factor. Poor differentiation of the tumour w as also an important prognostic factor at all ages; this became increasingl y apparent 2 years after diagnosis (KR 3.4, CI 1.5-7.7). Conclusion Comorbidity had a decisive influence on the prognosis for patien ts with localized prostate cancer. Because this effect was stronger in youn ger patients the assessment of comorbidity seems most important when evalua ting the risk of early death.