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Prostate cancer‐specific mortality burden by risk group among men with localized disease: Implications for research and clinical trial priorities
Author(s) -
Dee Edward Christopher,
Nezolosky Michelle D.,
Chipidza Fallon E.,
Arega Melaku A.,
Butler Santino S.,
Sha Sybil T.,
Mahal Brandon A.,
Nguyen Paul L.,
Yang David D.,
Muralidhar Vinayak
Publication year - 2020
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.24041
Subject(s) - medicine , relative risk , epidemiology , prostate cancer , population , disease , prostate , cancer , gynecology , confidence interval , environmental health
Abstract Objective To estimate contemporary population‐based patterns of the relative burden of prostate cancer‐specific mortality (PCSM) attributable to each N0M0 prostate cancer risk‐group, that may guide prioritization in research, trial design, and clinical practice. Methods We categorized 2004‐2015 Surveillance, Epidemiology, and End Results database patients by risk group (low, favorable intermediate, unfavorable intermediate, high, and very highrisk). Using the Fine‐Gray method, we calculated the relative burden of 10‐year PCSM attributable to each risk group. Results Among N = 337 162 men (6.8‐year median follow‐up; median age 65 years), the relative proportion of low‐, favorable intermediate‐, unfavorable intermediate‐, high‐, and very high‐risk diagnoses were 29.9% ( N = 100 969), 31.1% ( N = 104 696), 17.9% ( N = 60 360), 18.1% ( N = 61 023), and 3.0% ( N = 10 114). Within 10 years of diagnosis, among patients who died of prostate cancer ( N = 15 064), 5.0% ( N = 746) had low‐risk, 13.7% ( N = 2060) had favorable intermediate‐risk, 16.1% ( N = 2429) had unfavorable intermediate‐risk, 47.8% ( N = 7196) had high‐risk, and 17.5% ( N = 2633) had very high‐risk disease at diagnosis. Patients aged 65 and older accounted for 51.9% of all diagnoses and 72.3% of 10‐year PCSM. Although black patients accounted for 15.0% of low‐risk diagnoses, they accounted for 20.6% of 10‐year PCSM. White patients accounted for 80.3% of low‐risk diagnoses and 75.7% of 10‐year PCSM. Conclusion Although high‐risk and very high‐risk disease account for one‐fifth of diagnoses, they account for two‐thirds of 10‐year PCSM. Older patients and black patients with low‐risk disease accounted for a disproportionately large proportion of deaths. These findings support targeting research toward high‐risk disease and ensuring adequate representation of older and black men in clinical trials.