Does Prostate Cancer Have Common Comorbid Conditions?

A comorbidity is commonly defined as the presence of one or more additional medical conditions occurring at the same time. When looking at a primary condition, such as prostate cancer, all other conditions a person may possess simultaneously are considered to be comorbidities. Each additional condition is one comorbidity, however, when looking at the role of comorbidities in reference to a condition as a whole, researchers and providers will typically consider the effects of all additional conditions combined on the individual.¹

Role of comorbidities with prostate cancer

Comorbidities include both related and unrelated issues to the primary condition. With prostate cancer, for example, an individual may have chronic obstructive pulmonary disease (COPD) at the same time as their prostate cancer that has developed or has been occurring completely separate from the cancer. Conversely, when undergoing treatment such as hormone therapy or dealing with the stressors of a cancer diagnosis in general, an individual may develop depression as a result of fighting their prostate cancer battle. Although the depression may be a result of the prostate cancer diagnosis and treatment, it is considered a comorbidity in the same manner as the independent COPD.

Comorbidities and treatment

One of the biggest issues to consider when it comes to comorbidities is their impact on treatment options. Some studies have indicated that the presence of one comorbid condition, even if it is moderate to severe in nature, may not significantly impact treatment decisions. However, when multiple comorbidities are present, and a provider takes these into account, along with other factors such as age, stage and grade of the cancer, treatment options may be limited. One main reason for this is that aggressive or curative treatment options may provide more risk and cost than benefits. Although some treatment options could potentially add on some time to the life expectancy of an individual with prostate cancer, the time that would be added may be filled with additional side-effects to battle that greatly impact quality of life.

Additionally, many cases of prostate cancer are slow-growing and are diagnosed later in life, that especially for those with a significant number of comorbidities, the risk of prostate-cancer specific death may be much lower than death from other causes. Avoiding costly or potentially debilitating prostate cancer treatment options in favor of active surveillance techniques (close monitoring) may be the most beneficial for those with less than 10-20 years of life expectancy. However, comorbidities can present extremely different in each patient, and must be considered on a case by case basis. For example, one individual could have three comorbid conditions that are all manageable and be in relatively good health.

Conversely, another individual may only have one or two comorbid conditions, but these may be debilitating and leave an individual unable to handle any treatment or care for themselves. For this reason, some studies have suggested classifying and individual with comorbidities into difference categories including healthy (with well controlled comorbidities), vulnerable (with treatable or manageable comorbidities), frail (with poorly controlled comorbidities), and too sick (meaning unable to handle any treatment and instead receiving comfort care or active surveillance). Although an individual in the healthy or vulnerable category will have comorbidities, they may be well enough to handle more aggressive therapies.^2-3

Comorbidities and survival rates

Although the 10-year survival rate for local or regional prostate cancer is roughly 98%, this number typically decreases with the presence of increasing numbers of comorbidities and their severity, along with increasing age. One study for example estimated the 10-year survival rate for an individual over 75 years old with prostate cancer to be:

• 65% when accompanied by diabetes without associated organ damage
• 51% when accompanied by peripheral vascular disease
• 50% when accompanied by diabetes with organ damage
• 35% when accompanied by moderate to severe COPD

A similar study also reported significantly higher rates of other-cause mortality for those with non-metastatic prostate cancer, with this rates increasing even more as the number of comorbid conditions increased. This study reported that over a 14-year period, the rate of other cause mortality for these individuals who had no accompanying comorbid conditions was 24%, while others with one, two, or three or more comorbid conditions had other-cause mortality rates of 33%, 46%, and 57%, respectively.

Age and race have been shown to be a major factor in developing or already having additional conditions, with a greater number of conditions being present in older men, as well as in African American men. Common comorbidities present in these groups in addition to prostate cancer are high blood pressure, diabetes, ulcers, liver disease, obesity, depression, urinary issues, and sexual dysfunction.^1,4-6

Ultimately, your doctor will assess your personal risk due to comorbid conditions, and will help determine the best treatment approach for your specific situation in order to maximize your quality of life.