Cardiovascular comorbidity and treatment regret in men with recurrent prostate cancer

OBJECTIVE: • To determine whether cardiovascular comorbidity is associated with increased treatment regret among men with recurrent prostate cancer. METHODS: • The study cohort comprised 795 men in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry who experienced biochemical recurrence at a median (interquartile range) of 5.5 (2.8-9.1) years after prostatectomy (n = 410), external beam radiation therapy (n = 237), brachytherapy (n = 124) or primary androgen deprivation therapy (n = 24). • Multivariable logistic regression analysis was used to determine whether cardiovascular comorbidity was associated with treatment regret. • Cardiovascular comorbidity, which included myocardial infarction, congestive heart failure, angina, diabetes, stroke or circulation problems, was defined using a validated two-question screening process after adjusting for sociodemographic and treatment factors and post-treatment bladder and bowel toxicity. RESULTS: • Of 795 men, 14.8% reported regret. • Men with cardiovascular comorbidity were more likely to experience post-therapy bowel toxicity (P = 0.022). • In the adjusted multivariable model, the factors associated with increased treatment regret were: cardiovascular comorbidity (adjusted odds ratio [AOR] = 1.52 [95% CI:1.00-2.31], P = 0.048); younger age (AOR: 0.97 [95% CI 0.94-0.99] per year increase in age, P = 0.019); and bowel toxicity after treatment (AOR 1.58 [95% CI 1.03-2.43], P = 0.038). CONCLUSIONS: • Among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to experience treatment regret than men without cardiovascular comorbidity. • These data provide a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.