Abstract
IMPORTANCE: Geographic access to prostate cancer care may influence outcomes but is often measured using straight-line distance, which may not accurately capture the travel burden experienced by patients. OBJECTIVE: To evaluate the association between estimated travel time from patients' residence to treatment facilities and all-cause and prostate cancer-specific mortality. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the Multilevel Epidemiologic Tumor Registry for Oncology, a nationally representative, investigator-initiated, population-based cancer registry that integrates geomasked residential and treatment facility information from multiple US state cancer registries. The study included patients aged 40 to 99 years from Hawaii, Louisiana, Massachusetts, New Jersey, Ohio, Utah, and Washington (Seattle and Puget Sound areas) with prostate cancer diagnosed between January 1, 2000, and December 31, 2015, and follow-up through January 1, 2018. Patients with missing follow-up, diagnosis at autopsy, and missing residential or treatment facility data were excluded. The data were analyzed from May 1, 2024, to March 15, 2025. EXPOSURE: Travel time from residence to treatment facility, categorized as less than 30 minutes vs 30 minutes or longer, was estimated based on masked geocodes and road network data. MAIN OUTCOMES AND MEASURES: The primary outcomes were all-cause and prostate cancer-specific mortality measured using Cox proportional hazards regression models. RESULTS: The study included 159 943 men (mean [SD] age, 66.3 [9.5] years; median [IQR] follow-up, 101.2 [57.3-120.0] months), of whom 44.1% were estimated to have a less than 30-minute travel time and 55.9% to have a 30-minute or longer travel time. Those with a long travel time had a lower risk of death from any cause (adjusted hazard ratio, 0.91 [95% CI, 0.89-0.93]) and from prostate cancer (adjusted hazard ratio, 0.90 [95% CI, 0.86-0.95]). CONCLUSIONS AND RELEVANCE: This cohort study found that longer travel time to treatment facilities was associated with lower all-cause and prostate cancer-specific mortality, possibly reflecting better quality through care centralization at specialized centers. While consistent across most subgroups, the findings should be interpreted with consideration of access barriers, such as transportation, that may contribute to missed or delayed diagnoses.