Differences between rural and urban prostate cancer patients

Area of Science:

• Oncology
• Public Health
• Epidemiology

Background:

• Residency status, defined as rural area (RA), urban clusters (UC), or urban areas (UA), may influence prostate cancer (PCa) outcomes.
• Previous research has not definitively established the impact of residency status on PCa stage at diagnosis or cancer-specific mortality (CSM).

Purpose of the Study:

• To investigate the association between residency status (RA, UC, UA) and prostate cancer (PCa) stage at presentation.
• To evaluate the impact of residency status on cancer-specific mortality (CSM) and other-cause mortality (OCM) in PCa patients.
• To determine if residency status independently predicts mortality outcomes in PCa patients.

Main Methods:

• Utilized data from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2016) for newly diagnosed prostate cancer (PCa) patients.
• Employed propensity-score (PS) matching, cumulative incidence plots, and multivariate competing-risks regression (CRR) models for analysis.
• Categorized patients based on residency status: rural area (RA), urban clusters (UC), and urban areas (UA).

Main Results:

• No significant differences in PCa stage at presentation or cancer-specific mortality (CSM) were observed across RA, UC, and UA residency statuses.
• Higher 10-year other-cause mortality (OCM) rates were found in RA (27.2%) and UC (23.7%) compared to UA (18.9%) patients (p < 0.001).
• Multivariate competing-risks regression models identified RA (SHR 1.38) and UC (SHR 1.18) as independent predictors of increased OCM, even after PS adjustment.

Conclusions:

• Prostate cancer patients residing in rural areas (RA) and urban clusters (UC) exhibit a significantly higher risk of other-cause mortality (OCM) compared to those in urban areas (UA).
• Increased OCM suggests a potentially shorter life expectancy for RA and UC PCa patients.
• These findings underscore the importance of considering OCM and overall life expectancy in treatment decision-making for PCa patients, particularly those in non-urban settings.