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Epidemiology

Five-year survival of patients with late-stage prostate cancer: comparison of the Military Health System and the U.S. general population

British Journal of Cancer volume 128, pages 1070–1076 (2023)Cite this article

Subjects

Abstract

Background

While the 5-year survival rate for local and regional prostate cancer is nearly 100%, it decreases dramatically for advanced tumours. Accessibility to health care is an important factor for cancer prognosis. The U.S. Military Health System (MHS) provides universal health care to its beneficiaries, reducing financial barriers to medical care. However, whether the universal care translates into improved survival among patients with advanced prostate cancer in the MHS is unknown. In this study, we compared the MHS and the U.S. general population in survival of patients with advanced prostate cancer (stages III and IV).

Methods

The MHS patients (N = 5379) were identified from the Department of Defense’s (DoD) Automated Central Tumor Registry (ACTUR). Patients in the U.S. general population (N = 21,516) were identified from the Surveillance, Epidemiology, and End Results (SEER) programme. The two populations were matched on age, race, and diagnosis year.

Results

The ACTUR patients exhibited longer 5-year survival than the matched SEER patients (HR = 0.74, 95% CI = 0.67–0.83), after adjustment for the potential confounders. The improved survival was observed for ages 50 years or older, both White patients and Black patients, all tumour stages and grades. This was also demonstrated despite the receipt of surgery or radiation treatment.

Conclusions

MHS beneficiaries with advanced prostate cancer had longer survival than their counterparts in the U.S. general population.

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Fig. 1: Kaplan–Meier survival curve for ACTUR and SEER patients with late-stage prostate cancer diagnosed during 1987–2013.

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Data availability

The data sets generated during and/or analysed during the current study are not publicly available following DoD MHS regulations.

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Acknowledgements

The authors thank the Joint Pathology Center and the Surveillance, Epidemiology, and End Results (SEER) programme for the use of the cancer registry data.

Funding

This project was supported by John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.

Author information

Authors and Affiliations

  1. Murtha Cancer Center/Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Jie Lin, Craig D. Shriver & Kangmin Zhu

  2. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Jie Lin, Craig D. Shriver & Kangmin Zhu

  3. Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Jie Lin & Kangmin Zhu

  4. Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA

    Jie Lin, Darryl Nousome, Jiji Jiang & Kangmin Zhu

  5. Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Darryl Nousome, Jiji Jiang & Gregory T. Chesnut

  6. Urology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Gregory T. Chesnut

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  1. Jie Lin
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Contributions

Each of the authors (JL, DN, JJ, GTC, CDS, and KZ) significantly contributed to the project conception that led to data acquisition and results interpretation. All authors contributed to manuscript drafting, revision, and final approval. The corresponding author (KZ) confirmed that he had full access to the data in the study and final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Kangmin Zhu.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was based on the non-identifiable ACTUR data and SEER de-identified public use data. The study was approved by the institutional review board of Walter Reed National Military Medical Center. The study was performed in accordance with the Declaration of Helsinki.

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Not applicable.

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Lin, J., Nousome, D., Jiang, J. et al. Five-year survival of patients with late-stage prostate cancer: comparison of the Military Health System and the U.S. general population. Br J Cancer 128, 1070–1076 (2023). https://doi.org/10.1038/s41416-022-02136-3

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