The demographic variables of interest for these patients included age at diagnosis, sex, race, histology grade, sites of distant metastases (liver, lung, bone, and brain), and 5-year survival outcomes. Race was categorized as White, Black, and other (other and unknown). Histology grades were based on the 2014 SEER Gleason conversion table. For this analysis, we combined grades 1 and 2 and grades 3 and 4. Grades 1 and 2 are groups of patients with Gleason scores from 2 to 7 and histology ranging from well differentiated to moderately differentiated. Grades 3 and 4 are groups of patients with Gleason scores from 8 to 10 and poorly differentiated histology.

Distant metastases to the bone, liver, lung, and brain were examined. Brain metastasis only was identified as “code 1” and represented “mets at diagnosis”. Brain involvement could have been single or multiple sites and could have included clinical or pathological information. No brain metastasis was identified as “code 0”, which has no clinical or pathological or imaging evidence for brain metastasis.

We further inquired for liver, lung, and bone metastases in the patients with brain metastasis at diagnosis and patients without brain metastasis at diagnosis. Surgery at metastasis site, and chemotherapy were categorized into “yes” and “no/unknown” statuses. The SEER data provided only “surgery at metastasis” but there was no information provided on the location of the surgery at metastasis site; for example, brain surgery vs visceral surgery. However, we selected patients who presented with brain metastasis at the time of diagnosis. We assumed that “surgery at metastasis” site would refer to brain surgery, since visceral surgery would rarely be performed in patients having both brain and visceral metastases.

Survival was defined as the time from diagnosis until death due to all causes. We tracked survival outcomes for 5 years. Patients with missing or unknown information and TNM/AJCC staging were excluded.

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