We aimed to assess the association between comorbidities and prostate cancer management. We studied 12,603 South Australian men diagnosed with prostate cancer between 2003 and 2019. Comorbidity was measured one year prior to prostate cancer diagnosis using a medication-based comorbidity index (Rx-Risk). Binomial logistic regression analyses were used to assess the association between comorbidities and primary treatment selection (active surveillance, radical prostatectomy (RP), external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT), brachytherapy, ADT alone, and watchful waiting (WW)). Certain common comorbidities within Rx-Risk (cardiac disorders, diabetes, chronic airway diseases, depression and anxiety, thrombosis, and chronic pain) were also assessed. All models were adjusted for sociodemographic and tumor characteristics. Likelihood of receiving RP was lower among men with Rx-Risk score ≥3 (odds ratio (OR) 0.62, 95%CI:0.56-0.69) and Rx-Risk 2 (OR 0.80, 95%CI:0.70-0.92) compared with no comorbidity (Rx-Risk ≤0). Men with high comorbidity (Rx-Risk ≥3) were more likely to have received ADT alone (OR 1.76, 95%CI:1.40-2.21), EBRT (OR 1.30, 95%CI:1.17-1.45) or WW (OR 1.49, 95%CI:1.19-1.88) compared with Rx-Risk ≤0. Pre-existing cardiac and respiratory disorders, thrombosis, diabetes, depression and anxiety, and chronic pain were associated with lower likelihood of selecting RP and higher likelihood of EBRT (except chronic airway disease) or WW (except diabetes and depression and anxiety). Cardiac disorders and thrombosis were associated with higher likelihood of selecting ADT alone. Furthermore, age had greater effect on treatment choice than the level of comorbidity. High comorbidity burden was associated with primary treatment choice, with significantly less RP and more EBRT, WW and ADT alone among men with higher levels of comorbidity. Each of the individual comorbid conditions also influenced treatment selection.

中文翻译：

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基于药物的合并症措施和前列腺癌治疗选择

我们的目的是评估合并症与前列腺癌治疗之间的关联。我们研究了 2003 年至 2019 年间诊断出患有前列腺癌的 12,603 名南澳大利亚男性。在前列腺癌诊断前一年，使用基于药物的合并症指数 (Rx-Risk) 测量合并症。使用二项逻辑回归分析来评估合并症与主要治疗选择之间的关联（主动监测、根治性前列腺切除术（RP）、外照射放疗（EBRT）联合或不联合雄激素剥夺疗法（ADT）、近距离放射治疗、单独ADT和观察等待） （WW））。还评估了 Rx-Risk 中的某些常见合并症（心脏病、糖尿病、慢性气道疾病、抑郁和焦虑、血栓形成和慢性疼痛）。所有模型均根据社会人口统计学和肿瘤特征进行调整。与 Rx-Risk 评分≥3（比值比 (OR) 0.62，95%CI：0.56-0.69）和 Rx-Risk 2（OR 0.80，95%CI：0.70-0.92）的男性相比，接受 RP 的可能性较低无合并症（Rx-Risk ≤0）。合并症高（Rx-Risk ≥3）的男性更有可能接受单独 ADT（OR 1.76，95%CI：1.40-2.21）、EBRT（OR 1.30，95%CI：1.17-1.45）或 WW（OR 1.49） , 95%CI:1.19-1.88) 与 Rx-Risk ≤0 相比。预先存在的心脏和呼吸系统疾病、血栓形成、糖尿病、抑郁和焦虑以及慢性疼痛与选择 RP 的可能性较低以及选择 EBRT（慢性气道疾病除外）或 WW（糖尿病以及抑郁和焦虑除外）的可能性较高相关。心脏疾病和血栓形成与单独选择 ADT 的可能性较高相关。此外，年龄对治疗选择的影响比合并症水平的影响更大。高合并症负担与主要治疗选择相关，合并症水平较高的男性中 RP 显着减少，单独 EBRT、WW 和 ADT 增加。每一种合并症也影响治疗选择。