The current study has limitations. This includes the retrospective, nonrandomized approach to the review of medical information/data on patients with prostate cancer. In addition, the VA database did not analyze tertiary grades or specific numbers/percentages of positive cores in each prostate biopsy sample. Finally, disease-specific mortality is lacking which means that associated comorbidities in our patients may have contribute to the survival rates observed in our study.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30. 2. Shah RB, Zhou M. Recent advances in prostate cancer pathology: Gleason grading and beyond. Pathol Int 2016;66:260-72. 3. Blute ML, Bergstralh EJ, Iocca A, Scherer B, Zincke H. Use of gleason score, prostate specific antigen, seminal vesicle and margin status to predict biochemical failure after radical prostatectomy. J Urol 2001;165:119-25. 4. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostate cancer. Definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 2016;40:244-52. 5. Cole AI, Morgan TM, Spratt DE, Palapattu GS, He C, Tomlins SA, et al. Prognostic value of percent Gleason grade 4 at prostate biopsy in predicting prostatectomy pathology and recurrence. J Urol 2016;196:405-11. 6. Amin A, Partin A, Epstein JI. Gleason score 7 prostate cancer on needle biopsy: Relation of primary pattern 3 or 4 to pathological stage and progression after radical prostatectomy. J Urol 2011;186:1286-90. 7. Alenda O, Ploussard G, Mouracade P, Xylinas E, de la Taille A, Allory Y, et al. Impact of the primary Gleason pattern on biochemical recurrence-free survival after radical prostatectomy: A single-center cohort of 1,248 patients with Gleason 7 tumors. World J Urol 2011;29:671-6.

This may be attributed to the early, easy, and equal access to care afforded by the United States VA health-care system to all veterans.

VA hospitals in the same region pooled their data together. These hospitals were Biloxi, MS (BLX), Houston, TX (HOUSTON), Jacksonville, MS (JAX), Little Rock, AR (LR) and New Orleans, LA (NOLA).

Between 2009 and 2014, 1402 veterans were diagnosed with Gleason 7 prostate cancer. This patient population comprised of 1050 patients with GS3+4 prostate adenocarcinoma and 352 patients with GS4+3 cancers. The mean age at diagnosis was 63.6 years for the GS3+4 patients and 65.4 years for patients with GS4+3 cancers. Differences in demographics between GS3+4 and 4+3 patients have been detailed in [Table 1].{Table 1}

Data from the 2004 NHIS, which included more detail on military and VA coverage than did the CPS, showed that 7.2% of honorably discharged veterans were uninsured. An additional 7.8% of veterans reported receiving VA care, nearly half of whom (3.3% of veterans, 738000 people) had no other coverage.

Our encounters with uninsured veterans led us to explore 3 questions: are many veterans uninsured? Do uninsured veterans suffer problems in access to care similar to others who are uninsured? Is this a new problem?

The Veterans Eligibility Reform Act of 1996 opened VA enrollment to all veterans, although nonpoor veterans were required to make copayments of up to $50 per day for outpatient care. (Poor is defined by assets and an income threshold that varies with location and family size. In general, veterans earning more than $30 000 per year are not eligible for free care.)

In fact, only a minority of veterans-those disabled by military service-are automatically eligible for VA care.

Results. Nearly 1.8 million veterans were uninsured and not receiving Veterans Administration care in 2004.