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Abstract
Objectives To confirm the association of previously reported prognostic factors with future progression of localised prostate cancer using primary care data and identify new potential prognostic factors for further assessment in prognostic model development and validation.
Design Retrospective cohort study, employing Cox proportional hazards regression controlling for age, prostate specific antigen (PSA), and Gleason score, was stratified by diagnostic stage.
Setting Primary care in England.
Participants Males with localised prostate cancer diagnosedbetween 01/01/1987 and 31/12/2016 within the Clinical Practice ResearchDatalink database, with linked data from the National Cancer Registration andAnalysis Service and Office for National Statistics.
Primary and secondary outcomes Primary outcome measure was prostate cancer mortality. Secondary outcome measures were all-cause mortality and commencing systemic therapy. Up-staging after diagnosis was not used as a secondary outcome owing to significant missing data.
Results 10 901 men (mean age 74.38±9.03 years) with localised prostate cancer were followed up for a mean of 14.12 (±6.36) years. 2331 (21.38%) men underwent systemic therapy and 3450 (31.65%) died, including 1250 (11.47%) from prostate cancer. Factors associated with an increased risk of prostate cancer mortality included age; high PSA; current or ex-smoker; ischaemic heart disease; high C reactive protein; high ferritin; low haemoglobin; high blood glucose and low albumin.
Conclusions This study identified several new potential prognostic factors for prostate cancer progression, as well as confirming some known prognostic factors, in an independent primary care data set. Further research is needed to develop and validate a prognostic model for prostate cancer progression.
- prostate disease
- epidemiology
- primary care
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Footnotes
Twitter @sammerriel
Contributors SWDM conceived and designed the work that has led to this submission. He acquired the data and performed the analysis. He drafted the manuscript and approves the final version. He agrees to be accountable for all aspects of the work. As corresponding author, he also confirms he has full access to the data in the study and has taken final responsibility for the decision to submit for publication. SMI played an important role in the data analysis and interpretation of the results. She revised the manuscript and approved the final version. She agrees to be accountable for all aspects of the work. MTM helped design the work that has led to this submission, and supported interpretation of the results. She also provided study supervision to SWDM. She has revised the manuscript and approved the final version. She agrees to be accountable for all aspects of the work. RMM helped to conceive and design the work that has led to this submission. He also provided study supervision to SWDM. He has revised the manuscript and approved the final version. He agrees to be accountable for all aspects of the work.
Funding SWDM is supported by the Can Test Collaborative, which is funded by CRUK (C8640/A23385). This work was supported by an Academic Clinical Fellowship in Primary Care for SWDM, funded by the National Institute for Health Research and Health Education England. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health. RMM was supported by a CRUK programme grant, the Integrative Cancer Epidemiology Programme (C18281/A19169). MM was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. The funders had no direct role in the planning or undertaking of this study, or the preparation of this manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study received ethical approval from the Independent Scientific Advisory Committee (ISAC) of the Medicines and Healthcare products Regulatory Authority (MHRA)—Protocol reference 17_041. It was conducted in accordance with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. This study analysed a CPRD dataset, with linked NCRAS and ONS data. Permission was not sought to share the dataset publicly.
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