Click to Enlarge: Frequency of 90-day complications and readmissions by comorbidity level at prostate cancer diagnosis for men undergoing radical prostatectomy in the U.S. Military Health System, 2001-2014.
Note. General complications include myocardial infarction (MI), stroke, hemorrhage, blood transfusion, acute renal failure, deep vein thrombosis (DVT), pulmonary embolism (PE), other thrombosis, pneumonia, sepsis or septic shock, and death; Genitourinary complications include surgical site infection (SSI), pelvic abscess, hematoma, urinary tract infection, urinary incontinence (stress, urge, or mixed), bladder neck contracture (BNC), rectal injury, or rectal incontinence; Chi-square P-values are shown Source: Cancer Control
BETHESDA, MD — Men undergoing surgery for prostate cancer often present with more than their malignancy. Many also are managing chronic comorbidities such as cardiovascular disease, diabetes and hypertension.
A new analysis of patients treated within the U.S. Military Health System (MHS) suggested that those additional conditions can significantly increase both short- and long-term complications after radical prostatectomy, even in a setting designed to provide equal access to care.
Published in Cancer Control, the study evaluated 5,645 men diagnosed with nonmetastatic prostate adenocarcinoma between 2001 and 2014 who underwent surgery within a year of diagnosis. Using linked cancer registry and health system data, researchers tracked general and genitourinary complications, hospital readmissions within 90 days and urinary or sexual complications for up to 18 months after surgery.¹
Comorbidity burden was measured using the Elixhauser Index. In the cohort, 39.9% of patients had no comorbidities, 43.9% had one or two conditions, and 16.2% had three or more.
Risk increased steadily with each additional layer of illness, the study found. Men with three or more comorbidities faced nearly double the risk of 90-day general complications compared with those with none. They also experienced more genitourinary complications and were more likely to be readmitted to the hospital. At 18 months, both moderate and high comorbidity groups continued to show elevated rates of urinary and sexual dysfunction.
“These comorbidities may affect prostate cancer diagnosis, treatment, treatment effects and outcomes,” said Yvonne L. Eaglehouse, PhD, MPH, of the Murtha Cancer Center Research Program at the Uniformed Services University in Bethesda, MD. “Therefore, it is important to understand how comorbid conditions may impact cancer treatment outcomes, such as after prostate surgery, so that clinicians may implement appropriate preoperative and postoperative interventions to optimize treatment outcomes.”
The MHS offered a unique environment to further that understanding. Because men in the system have integrated, comprehensive coverages, it allowed researchers to better isolate how underlying health status itself—rather than barriers to care—influences recovery.
While higher short-term complication rates were not unexpected, the persistence of genitourinary problems well beyond the immediate postoperative period stood out, Eaglehouse said. “One of the more novel findings in our study was the increased risk of 18-month complications, especially urinary incontinence and erectile dysfunction, for those with higher pre-diagnostic comorbidity level.”
Among men who did not receive adjuvant radiation, those with more than three comorbidities had a 53% higher risk of urinary incontinence and a 39% higher risk of erectile dysfunction 18 months after surgery compared with healthier peers.
“This finding was unique in that not many prior studies included more than 12 months of follow-up nor assessed genitourinary outcomes separately for men with and without adjuvant radiation,” she added.
Although these outcomes might sound incremental on paper, Eaglehouse emphasized that they carry meaningful consequences for patients’ daily lives and treatment plans.
“The observed increases in short- and long-term complications for patients with higher comorbidity level are very important clinically,” she said. “Any complication can negatively affect patient satisfaction with treatment and health-related quality of life. Short-term complications may also affect receipt or timing of planned adjuvant treatment, which may affect patient and clinical outcomes.”
The findings suggest that managing surgical risk requires more than focusing on the tumor alone, Eaglehouse said. “[M]ultidisciplinary teams are essential to managing pre- and postoperative care of patients with prostate cancer and comorbidity,” she said, emphasizing coordination among primary care providers, oncology teams and relevant specialists.
While preparation may play a key role in mitigating complications for all patients, those with chronic conditions may benefit from additional attention to disease control and lifestyle changes.
“For those with comorbidity, adherence to interventions (e.g., prescribed medication, healthy lifestyle) may be of extra importance,” Eaglehouse told U.S. Medicine. “Patients with comorbidity may also be counseled to implement new interventions which could potentially reduce their risk.”
The researchers stated future research will need to examine how factors such as control of diabetes or degree of obesity influence outcomes.
- Eaglehouse YL, Dide-Agossou C, Darmon S, Kern SQ, Oroho MR, Almeida AA, Shriver CD, Zhu K. Comorbidity Level and Risk of 90-day and 18-month Complications Among Patients Undergoing Radical Prostatectomy for Prostate Cancer in the Military Health System. Cancer Control. 2026 Jan-Dec;33:10732748261420506. doi: 10.1177/10732748261420506. Epub 2026 Jan 21. PMID: 41565587; PMCID: PMC12833137.
