title: Current impact of age and comorbidity assessment on prostate cancer treatment choice and over/undertreatment risk.
abstract: OBJECTIVE
  We evaluated the influence of age and comorbidity (Charlson score assessment) on localized prostate cancer therapeutic management and the risk of prostate cancer over- and under-treatment.
  
  
  METHODS
  Among the 2571 prostate cancer cases diagnosed in 2011, a subset of 633 patients was randomly selected from the prospectively accrued cohort of the Regional Cancer Registry, among the 17 participating institutions. Treatment distributions were examined for patients at each individual prostate cancer risk, age and comorbidity level and analyzed by multivariate logistic regression analysis.
  
  
  RESULTS
  Treatments with curative intent were observed less often when age increased (p < 0.001). We found no impact of the Charlson score on the selection of a curative treatment [HR 0.89, 95 % CI (0.70-1.15)]. A 20 % overtreatment rate was reported in low-risk prostate cancer patients. For younger patients (65-75 years) with high comorbidity score, a 14 % overtreatment rate was observed. Conversely, a 16 % undertreatment rate was reported in older patients >75 years without any significant comorbidity.
  
  
  CONCLUSIONS
  A better consideration of comorbidities could significantly reduce overtreatment in patients <75 year and promote curative treatment in aggressive prostate cancer for older patients without any significant comorbidity.
authors.affiliation: University Hospital of Rangueil, Toulouse, France. pierrelunardi@hotmail.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lunardi
authors.affiliation: Urology Department, Saint Jean Languedoc Hospital, Toulouse, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.affiliation: National Cancer Registry, INSERM, Toulouse, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Grosclaude
authors.affiliation: University Hospital of Rangueil, Toulouse, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.affiliation: University Hospital of Rangueil, Toulouse, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
authors.affiliation: University Hospital of Rangueil, Toulouse, France.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Beauval
authors.affiliation: University Hospital of Rangueil, Toulouse, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Malavaud
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D015897:Comorbidity; D006801:Humans; D016015:Logistic Models; D008297:Male; D000069342:Medical Overuse; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011878:Radiotherapy / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors
keywords: Charlson score; Comorbidity; Overtreatment; Prostate cancer; Undertreatment