Age at Diagnosis and Postoperative Outcomes Among Men Treated for Prostate Cancer in the U.S. Military Health System

Background Access to care may influence differences in prostate cancer surgery and outcomes by age at diagnosis in the U.S. We studied age in relation to prostate cancer surgical outcomes in the Military Health System (MHS) which provides universal healthcare access. Methods We identified men aged ≥ 18 diagnosed with prostate adenocarcinoma from 2001 to 2014 receiving radical prostatectomy (RP). Outcomes included 90-day postoperative general and genitourinary (GU) complications and hospital readmissions and 18-month postoperative GU complications. Multivariable Poisson regression estimated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) for the outcomes in association with age at diagnosis (18-54, 55-64, and ≥ 65 years). Results The study included 1627 men aged 18 to 54 years, 2543 men aged 55 to 64 years, and 969 men aged ≥ 65 years. Overall, age ≥65 was associated with higher risk of 90-day general complications (ARR = 1.72, 95% CI = 1313, 2.27), GU complications (ARR = 1.13, 95% CI = 1.01, 1.27), and readmissions (ARR = 1.45, 95% CI = 1.05, 1.99) relative to age 55 to 64. At 18-months post-RP, age ≥ 65 was associated with higher risk of urinary tract infection overall (ARR = 1.79, 95% CI = 1.01, 3.20) and urinary incontinence (ARR = 1.55, 95% CI = 1.15, 2.08) and bladder neck contracture (1.88, 95% CI = 1.08, 3.27) among men without adjuvant radiation relative to age 55 to 64. Conclusions In the MHS, age ≥ 65 years was associated with higher rates of postoperative outcomes for men with prostate cancer receiving RP. More research is needed to understand what factors contribute to age differences in prostate cancer outcomes in systems with universal healthcare access.