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



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).


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.


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.


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.

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


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.

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Authors and Affiliations



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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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).

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