Follow-up Prostate Cancer Treatments After Radical Prostatectomy: a Population-Based Study

e16553 Background: This population-based study assesses the relationship between insurance status and patterns of prostate cancer diagnosis and treatment among men under age 65. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 114,871 prostate cancer patients who were diagnosed before 65 between January 2007 and December 2013. Insurance type was classified as uninsured (3.1%), Medicaid (5.1%) and other including private insurance and coverage from the military or Veterans Affairs (91.8%). We used logistic regression model to quantify the relative risk of being diagnosed with metastasis or regional disease, and the relative likelihood of receiving radical prostatectomy or radiotherapy among those with localized cancer adjusted by, age, race, marital status, region, and diagnosis period. Results: Medicaid or uninsured patients are more likely to have late diagnosis (diagnosed with positive lymph node or metastasis) than patients with non-Medicaid insurance (Table 1). Among men diagnosed with localized prostate cancer, Medicaid and uninsured patients are less likely to receive prostatectomy. Medicaid patients are more likely to have radiotherapy than un-insured (see table). Conclusions: Compared with patients with non-Medicaid insurance, Medicaid and uninsured patients are more likely have late diagnosis and less likely to have radical prostatectomy for localized cancer, after accounting for differences in age, race, marital status, region, and diagnosis period. [Table: see text]

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Impact of putative chemopreventative agents on prostate cancer diagnosis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.40 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 40-40

Author(s):

Hanan Goldberg ◽

Faizan Moshin ◽

Zachary William Abraham Klaassen ◽

Thenappan Chandrasekar ◽

Christopher Wallis ◽

...

Keyword(s):

Prostate Cancer ◽

Cox Regression ◽

Large Population ◽

Multivariable Analysis ◽

Population Based ◽

Cumulative Exposure ◽

Population Based Study ◽

Diagnosis Rate ◽

The Impact

40 Background: Prostate cancer (PC) is the most common non-cutaneous cancer in Canadian men and the third most common cause of cancer death in Canada. Several studies have shown that use of commonly prescribed medications, including those used for diabetes and hypercholesterolemia, is associated with improved survival in various malignancies, including PC. There has not been any large population-based study, examining the effects of these and other commonly prescribed medications, on the rate of PC diagnosis, over a 20 years follow-up period. Methods: A retrospective population-based study using data from the institute of clinical evaluative sciences, including all male patients aged 65 and above in Ontario who have had a negative first prostate biopsy between 1994 and 2016. We assessed the impact of commonly prescribed medications on PC diagnosis. The medications included Statins (hydrophilic and hydrophobic), diabetes drugs (metformin, insulins, sulfonylureas, and thizolidinedions), proton pump inhibitors, 5 alpha reductase inhibitors, and alpha blockers. Time dependent Cox regression proportional hazards models were performed determine predictors of PC diagnosis. Medication exposure was time varying and modeled as “ever” vs. “never” use or as cumulative exposure for 6 months of usage. A priori variables included in the model included age, ADG comorbidity score, rurality index, index year, and all medications. Results: A total of 51,415 men were analyzed over a mean (SD) follow-up time of 8.06 (5.44) years. Overall, 10,466 patients (20.4%) were diagnosed with PC, 16,726 (32.5%) had died, and 1,460 (2.8%) patients died of PC. On multivariable analysis increasing age and rurality index were associated with higher PC diagnosis rate, while a more recent index year, and usage of hydrophilic statins was associated with a lower diagnosis rate in both “ever” vs. “never” and cumulative models (HR 0.832, 95% CI 0.732-0.946, p = 0.005, HR 0.973 95% CI 0.951-0.995, p = 0.016, respectively). Conclusions: Hydrophilic statins are associated with a clinically significant lower PC diagnosis. To our knowledge this is the first study demonstrating a clear advantage of one group of statins (hydrophilic) over another (hydrophobic) in PC prevention.

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