Abstract
To analyze cancer-specific mortality (CSM) and other-cause mortality (OCM) among patients with prostate cancer that initiated treatment in the Brazilian Unified Health System (SUS), between 2002 and 2010, in Brazil. Retrospective observational study that used the National Oncological Database, which was developed by record-linkage techniques used to integrate data from SUS Information Systems, namely: Outpatient (SIA-SUS), Hospital (SIH-SUS), and Mortality (SIM-SUS). Cancer-specific and other-cause survival probabilities were estimated by the time elapsed between the date of the first treatment until the patients' deaths or the end of the study, from 2002 until 2015. The Fine-Gray model for competing risk was used to estimate factors associated with patients' risk of death. Of the 112,856 studied patients, the average age was 70.5 years, 21% died due to prostate cancer, and 25% due to other causes. Specific survival in 160 months was 75%, and other-cause survival was 67%. For CSM, the main factors associated with patients' risk of death were: stage IV (AHR = 2.91; 95%CI 2.73 - 3.11), systemic treatment (AHR = 2.10; 95%CI 2.00 - 2.22), and combined surgery (AHR = 2.30, 95%CI 2.18 - 2.42). As for OCM, the main factors associated with patients' risk of death were age and comorbidities. The analyzed patients with prostate cancer were older and died mainly from other causes, probably due to the presence of comorbidities associated with the tumor.
Highlights
Prostate cancer is the second most frequent cancer and the fifth leading cause of cancer death in men worldwide
The incidence and mortality rates of prostate cancer worldwide are strongly related to age, with the highest incidence observed in older men, and almost 55% of all deaths occurred in men aged over 65 years[4]
The increase in incidence in Brazil is related to population aging and, as in other countries, to the spread of Prostate-Specific Antigen (PSA) in the 1990s in the diagnosis of this neoplasm[4,5,6]
Summary
Prostate cancer is the second most frequent cancer and the fifth leading cause of cancer death in men worldwide. In 2018, the incidence and mortality estimates registered about 1.3 million new cases and 358,989 deaths in the world[1,2]. In Brazil, 68,220 new prostate cancer cases and 15,391 deaths were estimated in 20183. The incidence and mortality rates of prostate cancer worldwide are strongly related to age, with the highest incidence observed in older men, and almost 55% of all deaths occurred in men aged over 65 years[4]. The increase in incidence in Brazil is related to population aging and, as in other countries, to the spread of Prostate-Specific Antigen (PSA) in the 1990s in the diagnosis of this neoplasm[4,5,6]. Age is the main risk factor for prostate cancer; approximately 60% of diagnosed cases occurred in men aged over 60 years[7]. Methods designed for such analyses should be employed, such as Fine and Gray’s method for competitive risks[13,14,15,16,17], whereas many studies use traditional methods such as the Kaplan-Meier estimator and Cox’s proportional hazards model[18,19]
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