title: Consideration of comorbidity in risk stratification prior to prostate biopsy.
abstract: BACKGROUND
  Previously, the patient-reported Total Illness Burden Index for Prostate Cancer (TIBI-CaP) questionnaire and/or the physician-reported Charlson Comorbidity Index (CCI) have provided assessments of competing comorbidity during treatment decisions for patients with prostate cancer. In the current study, the authors used these assessments to determine comorbidity and prognosis before prostate biopsy and the subsequent diagnosis of prostate cancer to identify those patients least likely to benefit from treatment.
  
  
  METHODS
  A prospective observational cohort study was performed of 104 participants aged 64.0 years ± 6.5 years from 3 institutions representing different health care delivery systems. Patients were identified before undergoing transrectal ultrasound-guided prostate biopsy and followed for a median of 28 months. Associations between the comorbidity scores and nonelective hospital admissions were investigated using logistic regression and Cox proportional hazards models.
  
  
  RESULTS
  Among the 104 patients who underwent prostate biopsy, 2 died during the follow-up period. The overall hospital admission rate was 20% (21 of 104 patients). Higher scores on both the TIBI-CaP (≥ 9) and CCI (≥ 3) were found to be significantly associated with an increased odds for hospital admission (odds ratio, 11.3 [95% confidence interval (95% CI), 2.4-53.6] and OR, 5.7 [95% CI, 1.4-22.4]) and hazards ratios (HRs) for time to hospital admission (HR, 3.8 [95% CI, 1.3-11.2] and HR, 3.2 [95% CI, 1.1-9.1]), respectively.
  
  
  CONCLUSIONS
  TIBI-CaP and CCI scores were found to successfully predict which patients were at high risk for nonelective hospital admission. These patients are likely to have poorer health and a potentially shortened lifespan. Therefore, comorbidity analysis using these tools may help to identify those patients who are least likely to benefit from prostate cancer therapy and should avoid prostate biopsy.
authors.affiliation: Department of Urology, University of California at Irvine, Irvine, California, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: John
authors.initials: J
authors.lastname: Billimek
authors.forename: Kathryn
authors.initials: K
authors.lastname: Osann
authors.forename: Jane
authors.initials: J
authors.lastname: Cho
authors.forename: Ross
authors.initials: R
authors.lastname: Moskowitz
authors.forename: Adam
authors.initials: A
authors.lastname: Kaplan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Szabo
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.forename: Atreya
authors.initials: A
authors.lastname: Dash
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods / Q000592:standards; D015897:Comorbidity; D017281:Cost of Illness; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D012007:Rectum; D011795:Surveys and Questionnaires