Cancer Causes & Control

, Volume 30, Issue 6, pp 627–635 | Cite as

Race and overall survival in men diagnosed with prostate cancer in the Department of Defense Military Health System, 1990–2010

  • Melannie Alexander
  • Kangmin Zhu
  • Jennifer Cullen
  • Celia Byrne
  • Derek Brown
  • Stephanie Shao
  • Jennifer RusieckiEmail author
Original Paper



In the U.S. general population, black men experience poorer survival after prostate cancer (CaP) diagnosis compared to white men, and findings may be impacted by unequal access to healthcare. The objective of the study is to investigate racial differences in overall survival (OS) among Department of Defense beneficiaries diagnosed with CaP.


A retrospective cohort study was conducted utilizing the Automated Central Tumor Registry within the Military Healthcare System, a system designed to provide equal access. Men diagnosed with primary prostate adenocarcinomas between 1990 and 2010 [n = 18,484; 24% Non-Hispanic black (NHB), 76% Non-Hispanic white (NHW)] were followed through 2013 for vital status. Unadjusted Kaplan–Meier estimation curves and multivariable Cox proportional hazards (PH) regression models were used to examine racial differences in OS.


Age-specific Kaplan–Meier analyses showed equivalent OS for NHW and NHB men in all age groups, except for 75+, where NHB had poorer OS (p = 0.0048). Multivariable Cox PH models revealed no significant differences in OS for race (HR 1.02; 95% CI 0.95–1.08), except in men aged ≥ 75 years, where NHB men had poorer OS (HR 1.27; 95% CI 1.08–1.49).


Findings suggest that in a healthcare system designed for equal access, disparities in OS among men diagnosed with CaP may not exist.


Prostate cancer Survival Racial disparities Equal access 



This project was supported by John P. Murtha Cancer Center, Walter Reed National Military Medical Center via the Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine. The authors thank the Joint Pathology Center (formerly Armed Forces Institute of Pathology) for providing the data. The authors would like to thank Ms. Elizabeth Butts for her input about the ACTUR and its compliance with the Commission on Cancer.


The content of this publication is the sole responsibility of the authors and does not necessarily reflect the views or policies of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), or the Departments of the Army, Navy, or Air Force.


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  • Melannie Alexander
    • 1
    • 2
  • Kangmin Zhu
    • 2
  • Jennifer Cullen
    • 3
  • Celia Byrne
    • 1
  • Derek Brown
    • 2
  • Stephanie Shao
    • 2
  • Jennifer Rusiecki
    • 1
    Email author
  1. 1.Department of Preventive Medicine and BiostatisticsUniformed Services University of the Health SciencesBethesdaUSA
  2. 2.John P. Murtha Cancer CenterWalter Reed National Military Medical CenterBethesdaUSA
  3. 3.Department of Surgery, Center for Prostate Disease ResearchUniformed Services University of the Health SciencesBethesdaUSA

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