How socioeconomic and clinical factors impact prostate‐cancer‐specific and other‐cause mortality in prostate cancer stratified by clinical stage: Competing‐risk analysis

Abstract

Background The aim of this study was to analyze the causes of death and risk factors of prostate‐cancer‐specific mortality (PCSM) and other‐cause mortality (OCM) at different clinical stages using data from the Surveillance, Epidemiology, and End Results database. Methods The characteristics and cause‐specific death classifications of males with prostate cancer (PCa) were extracted. Multivariate competing‐risk regression analysis was used to identify significant predictors and quantify the cumulative incidence of PCSM and OCM at different clinical stages. Results Of the 244,433 PCa patients who were included, 19,274 died from 7356 PCSM, and 11,918 from OCM. The proportion of PCSM gradually increased from 2010 to 2016. The risk factors for PCSM in the localized PCa stage included older age, not being married, living in a county with higher poverty rates, and higher PSA levels and Gleason scores. Meanwhile, Medicaid and lower education levels were the additional risk factors of OCM. The risk factors for PCSM in the regional PCa stage included older age, not being married, Medicaid, living in a county with higher poverty rates, and higher PSA levels and Gleason scores. Meanwhile, the income level did not affect OCM risk. The risk factors for PCSM in the distant metastatic PCa stage included a separated/divorced/widowed marital status, Medicaid, and higher PSA levels and Gleason scores. Meanwhile, older age, an unmarried or separated/divorced/widowed marital status, and higher PSA levels were risk factors for OCM. In addition, receiving both surgery and radiation was worse than just receiving surgery for PCa specific survival in localized and regional PCa patients. Conclusion Some pretreatment and treatment factors may influence OCM that are not identical to those for PCSM at the corresponding stage. Decision‐makers and managers should fully consider OCM to maximize treatment benefits for PCa.

Influencing factors for mortality in prostate cancer patients with T1 and T2 stage: a retrospective cohort study

“…Additionally, T2 stage patients had better prognosis compared to T1 patients, and this may be due to the heterogeneity of PCa, with some T1 patients showing a worse outcome than those with T2 stage ( 28 ). In the present study, patients with higher SES scores were associated with a better outcome, which was consistent with the result of previous studies ( 20 , 29 ). A higher SES score suggests a better socio-economic status.…”

“…Our results showed that age at diagnosis was an influencing factor for mortality in patients with localized PCa. A similar result was reported in a previous competing risk regression analyze on mortality data ( 19 , 20 ). An increased risk of it with an elevated age at the time of diagnosis for older adults.…”

“…More comprehensive and in-depth research related to this are warranted in the future. A previous study indicated that the PSA levels and Gleason scores are powerful predictors of PCa prognosis ( 20 ), and its prognostic role in localized PCa should not be overlooked. Indeed, our study demonstrated that higher PSA levels and Gleason scores in localized PCa patients were associated with an increased risk of death.…”

“…A higher SES score suggests a better socio-economic status. In general, localized PCa patients with lower SES have a higher comorbidity burden and poorer lifestyle (such as smoking, lack of exercise, obesity), which might affect the outcome of the patients ( 20 ). Furthermore, high SES may provide timely and high-quality cancer care ( 30 ).…”

“…Whites tend to have greater access to health insurance and treatment, and more frequent early screening can help improve outcomes (23). As to therapeutic method, the risk of death for people who underwent radiotherapy was significantly increased than those without radiotherapy, which maybe because these patients were at higher risk of dying from cancer-specific (20), and its prognostic role in localized PCa should not be overlooked. Indeed, our study demonstrated that higher PSA levels and Gleason scores in localized PCa patients were associated with an increased risk of death.…”