Survival and Mortality Predictors in Prostate Cancer: A Retrospective Cohort of 10 556 Brazilian Patients

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ABSTRACT Background Prostate cancer (PCa) remains one of the most frequently diagnosed malignancies worldwide and represents a major contributor to premature mortality among men. This study aimed to estimate survival and investigate factors associated with PCa‐specific mortality among men treated within the oncology care network of a Brazilian state. Material and Methods Retrospective cohort study was conducted using data obtained from hospital‐based cancer registries linked to the state Mortality Information System. The cohort included 10 556 men diagnosed with PCa between 2000 and 2016, with follow‐up through 2021. Outcomes were categorized as death from PCa, death from other causes, or alive at the end of follow‐up. Associations with PCa‐specific mortality were examined using cause‐specific Cox proportional hazards regression models. Results At the end of 2021, 6388 patients were alive, 1936 had died from PCa and 2232 deaths from other causes. The 5‐year PCa‐specific survival was 87.7%. In the multivariable analysis, increasing age at diagnosis (per 10‐year increment) was associated with a higher cause‐specific hazard of PCa mortality (HR = 1.14; 95% CI: 1.06–1.22). Lower educational level was also associated with increased mortality, while patients with basic education (HR = 0.82; 95% CI: 0.71–0.95) and middle or high education (HR = 0.64; 95% CI: 0.52–0.80) showed a lower risk of death compared to those with no formal education. Referral from non‐SUS services was associated with a slightly higher risk of PCa mortality (HR = 1.14; 95% CI: 1.00–1.30). Regarding treatment variables, surgery was associated with a lower cause‐specific hazard of mortality (HR = 0.41; 95% CI: 0.33–0.52), whereas hormone therapy was associated with an increased cause‐specific hazard of death (HR = 1.98; 95% CI: 1.75–2.24). Conclusions Age, educational level, presence of distant metastasis, referral source, and treatment modalities were associated with PCa‐specific mortality. However, treatment‐related associations should be interpreted with caution, as they likely reflect underlying disease severity and treatment selection patterns rather than causal effects. These findings highlight the importance of early diagnosis, reducing social inequalities in access to care, and strengthening oncology care networks to improve outcomes in patients with PCa.