Two written assessments that identify existing comorbidities can successfully target which patients with prostate cancer would not benefit from biopsy, according to a new study. The assessments are the Total Illness Burden Index for Prostate Cancer, a patient-reported tool, and the Charlson Comorbidity Index, a physician-reported tool.
The study authors claim prostate biopsy may not be necessary in all men when comorbidities are taken into consideration. The study does not preclude the use of prostate-specific antigen (PSA) screening, but it does set the stage for a new and much more targeted strategy for biopsy choice. The desired result is fewer unneeded biopsies and fewer invasive treatments that can produce side effects.
An estimated 20% of men would be considered at high risk for death or hospitalization, and they should consider not undergoing a biopsy. The study results appeared in the journal Cancer (2013; doi:10.1002/cncr.28044).
The study included 104 patients who were assessed with the assessment tools before undergoing transrectal ultrasound-guided prostate biopsy. The patients were followed for a median of 28 months. Higher scores on both assessments were significantly associated with higher odds of hospital admission. The overall hospitalization rate was 20%, and two patients died during the follow-up period.
Both poor health and a potentially shortened lifespan are likely for patients with higher scores. This suggests that these patients are least likely to benefit from prostate cancer therapy, and, thus, should avoid prostate biopsy.
“Before prostate biopsy, providers should assess the number and severity of the patient’s comorbid conditions to discuss whether proceeding with biopsy or therapy is likely to be beneficial,” said corresponding author Atreya Dash, MD, a urologist at the University of Irvine Health, Orange, California.