Factors Associated With Risk Stratification and Overall Survival of Black South African Men With Non‐Metastatic Prostate Cancer

BACKGROUND: Emerging evidence indicates significantly poorer overall survival for men with metastatic prostate cancer in resource-limited settings than in high-income countries. However, there is less understanding of the overall survival of non-metastatic disease, which could inform early treatment strategies. OBJECTIVE: To prospectively examine factors associated with the National Comprehensive Cancer Network (NCCN) risk stratification and overall survival in 741 Black South African men with non-metastatic prostate cancer, some of whom also had co-morbidities (≥ 2 other chronic conditions). METHODS: Baseline data on social and health factors were collected. Follow-up of participants monitored overall survival over a median of 4.3 (3.5-5.0) years. We used multivariable proportional ordinal regression to examine factors associated with non-metastatic prostate cancer risk stratification. Kaplan-Meier, Cox proportional hazards regression, and Pohar-Perme methods were used to calculate overall survival and assess associations. RESULTS: Our findings showed a generally favourable prognosis of non-metastatic prostate cancer with a 5-year overall survival of 79.0% (75.6-82.6) while the 5-year age-standardised net survival was 91.0% (95% CI 86.0-97.0). Overall survival differed significantly by the different NCCN risk groups, emerging early and widening over time, with the lowest survival in the high-risk groups. Only older age at diagnosis (Hazard Ratio per one-year increase:1.05 (95% CI: 1.02-1.08)), diabetes (HR: 1.70 (95% CI: 1.08-2.67)), and depression (HR: 1.67 (95% CI: 1.09-2.57)) at study recruitment were associated with poorer overall survival. Furthermore, only older age at diagnosis (HR: 1.04 (95% CI: 1.02-1.07)) was associated with higher non-metastatic prostate cancer risk. CONCLUSIONS: These findings emphasise the need to address early diagnosis and comorbidities in non-metastatic prostate cancer, which could improve overall survival.