Introduction

Previous studies showed that higher Charlson comorbidity index increased the risk of overall mortality after radical prostatectomy. However, the relationship between comorbidities and prostate cancer-specific outcomes is less well established. While Charlson comorbidity index is a good measurement of health status, it is difficult to capture in retrospective data. Thus, we tested whether a man's overall health status, as reflected by the ASA (American Society of Anesthesiology) score, at the time of radical prostatectomy was associated with more distant prostate cancer-specific outcomes, such as biochemical recurrence (BCR), metastasis, and prostate cancer-specific mortality (PCSM).

Methods

Data were retrospectively collected on 3102 men who underwent RP between 1992 and 2015 at six Veterans Affairs hospitals in the SEARCH database. Cox proportional hazards analysis was used to test the association between ASA score and BCR, metastasis, all-cause mortality, and PCSM. Models were adjusted for age, race, year of surgery, surgical center, BMI, PSA, biopsy Gleason score, and clinical stage. As 98% of men had a ASA score of 2 or 3, we categorized ASA score as 1-2 vs. 3-4.

Results

There were 1419 (46%) men with ASA score 1-2 and 1683 (54%) men with ASA score 3-4. Men with ASA score 3-4 were older (mean 62 vs. 61), had more recent year of surgery (median 2009 vs. 2007), higher BMI (median 28.6 vs. 27.8), and higher biopsy Gleason score, versus men with ASA score 1-2 (all p<0.001). Men in the higher ASA group had an increased risk of all-cause mortality compared to men in the lower ASA grouping (HR 1.59, p<0.001). There was no increased risk of BCR (p=0.23), metastasis (p=0.22), or PCSM (p=0.83).

Conclusions

We found that men who underwent radical prostatectomy for prostate cancer with worse baseline health, as reflected by a higher ASA score (3-4 vs. 1-2), had a higher risk of all-cause mortality but did not have higher risk of the adverse prostate-cancer specific outcomes of BCR, metastasis, or death from prostate cancer. Whether similar results would be obtained if a more granular measure of comorbidity had been used remains to be tested.

Funding

none