Abstract
PurposeProstate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden.MethodsWe performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD.ResultsDUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis.ConclusionsMen with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment.
Highlights
Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide [1, 2]
This study population was 1,493,595. Another secondary analysis was conducted where we examined the association between drug use disorder (DUD) and prostate cancer mortality, while restricting to cancer stages I–III and adjusting for cancer stage
The majority (52.2%) had 9 years or less of education, 3.1% had received social welfare, 72.6% were married/cohabiting, 40.4% were living in large cities, and 21.8% were born outside Sweden (Table 1)
Summary
Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide [1, 2]. Men with drug use disorder (DUD) may have a higher risk of prostate cancer incidence and mortality because of delayed diagnosis and/or undertreatment. Several SES factors, for example neighborhood deprivation, being unmarried, or having low income or educational attainment, have been associated with increased prostate cancer risk and worse prostate cancer prognosis [22]. Lifestyle factors such as tobacco smoking and negative alcohol-related consequences are overrepresented among people with low SES [23, 24] or DUD [25,26,27,28,29], and are identified as. Approximately half of the Swedish male population age 50–70 have had a prostate specific antigen (PSA) test, which is offered free of charge to men over 50 years on their own initiative [34]
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