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Prostate cancer survivorship, deaths, and health care management

Prostate cancer (PCa) remains an important public health burden. According to data from the American Cancer Society, PCa will account for an estimated 248,530 of all new cancer cases (26%) in males in the United States during 2021. It is also estimated that there are currently more than 3.6 million male survivors in this country who are living with PCa, and this total number is projected to grow to more than 5 million male survivors by 2030. A major context for Weiner et al’s article titled “Cause of Death During Prostate Cancer Survivorship: A Contemporary, US Population– Based Analysis,” which appears in this issue of Cancer, is that both the number of PCa survivors and the proportion of male PCa survivors as a part of the total male cancer survivor population are increasing. Currently, approximately 4 in every 10 cancer survivors are PCa survivors, and by the end of this decade, that proportion will increase to nearly 5 in every 10. Trying to determine causes of death after a diagnosis of PCa, Weiner et al conducted a retrospective cohort study that was exploratory in nature, but they used a strong study design to compensate for limitations of previous studies. They assessed contemporary, populationbased data for causes of death during PCa survivorship in the United States by using the National Cancer Institute’s Surveillance, Epidemiology, and End Results 18 registries, which collect data on approximately 34.6% of the US population, from 2000 to 2016. Previous work has demonstrated that the regions of the United States reported by the Surveillance, Epidemiology, and End Results program tend to be broadly generalizable to the general United States. The authors also obtained additional access to the radiation/chemotherapy specialized data set, which was also used for analysis. Causes of death after a PCa diagnosis were then stratified by patient characteristics and tumor stage. Finally, they compared the risk of death for each cause with the general US population. Straightforward, conservative statistical analyses were performed on the data. The causes of death for men with local/regional PCa as well as the causes of death for men with distant PCa were investigated. Additionally, there was an assessment of year of diagnosis and stage at diagnosis. Succinctly, men with earlystage PCa are 4fold more likely to die of other causes, whereas those with advancedstage PCa have an increased risk of several non– cancerrelated causes in comparison with the general population. The work of Weiner et al should be understood within the context of the coronavirus disease 2019 (COVID19) pandemic. Health care for patients with PCa can be characterized as an acute and intense period of treatment and surveillance administered by oncology teams. The health care management of patients with PCa has become more challenging with respect to prioritization, access to treatment, multiple adjustments, and attempts to tailor approaches. Obek et al published a review and synopsis of currently available recommendations for the optimal management of patients with PCa during the pandemic. If we extend that continuum, there is a slow transition into an extended phase of survivorship care provided by primary care physicians. Survivorship health care is often more complex, with lateand longterm physical and psychological effects, and ideally requires a multidisciplinary approach. Major/frequent concerns for survivorship assessment include cardiac toxicities, anxiety and depression, fatigue, pain syndromes, sexual dysfunction, sleep disorders, and the ability to maintain a healthy lifestyle. The work by Weiner et al highlights that a number of these concerns affect health trajectories and increase mortality from noncancer causes of death for PCa survivors. The pandemic has led to further stressors on all cancer survivors and health care systems and has led to decreased use of health care services, with priority placed on the initial cancer diagnosis and treatment. Cancer survivors have also indicated that they have been fearful of coming into health care settings because of concerns about susceptibility to COVID19, and this has left them to manage physical and practical issues and worries on their own. 12 Health care management of