Association of Patient Comorbidities with Treatment Regret Among Patients with Localized Prostate Cancer – Results from a Population-Based Cohort

Decision regret is a well-established, negative outcome in prostate cancer. We hypothesized that baseline comorbidities, which impact treatment tolerability, are associated with regret. In a prospective, population-based cohort of prostate cancer patients, patient-reported regret was assessed at 12 months after treatment using a validated measure. Comorbidities were assessed using medical record abstraction and scored using the validated NCI Comorbidity Index. Multivariable logistic regression assessed the association between comorbidity score with regret, accounting for treatment-related symptoms, treatment received, and sociodemographic measures. This is a diverse cohort with 25.3% Black and 24.2% living in rural areas. A total of 108 out of 981 patients (11%) reported regret. On multivariable analysis, comorbidity burden (OR 1.58, p<.05), not married (OR 1.72, p=.04), worsening of bowel symptoms (OR 2.12, p<.01) and worsening of urinary obstruction/irritation (OR 1.60, p=.05) were associated with decision regret. In addition, radiation therapy was associated with less regret compared to radical prostatectomy (OR 0.48, p=.015). Among men with localized prostate cancer, baseline comorbidity burden is associated with increased decision regret. These results illustrate the importance of assessing baseline comorbidities and incorporation of its consideration in the treatment decision-making process, to ensure that patients have realistic expectations and make an informed decision.