Association of Low Socioeconomic Status With Adverse Prostate Cancer Pathology Among African American Men Who Underwent Radical Prostatectomy |
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| Affiliation: | 1. Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA;2. Division of Urology, University of Pennsylvania Health System, Philadelphia, PA;1. Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy;2. Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche, Naples, Italy;1. Division of Urology, University of Colorado–Denver, Denver, CO;2. Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT;3. Department of Radiation Oncology, Yale University, New Haven, CT;4. Department of Medicine, Yale University, New Haven, CT;5. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN;6. Division of Bioethics, Mayo Clinic, Rochester, MN;7. Department of Medicine, Mayo Clinic, Rochester, MN;8. Division of Health Policy & Research, Mayo Clinic, Rochester, MN;9. Department of Urology, University of Minnesota, Minneapolis, MN;10. Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA;11. Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH;12. Louis Stokes, Cleveland VA Medical Center, Cleveland, OH;13. University of Texas Medical Branch, Division of Urology, Galveston, TX;1. Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium;2. Department of Radiology, University Hospitals Leuven, KU Leuven, Leuven, Belgium;3. Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium;4. Inserm UMR1162, Université Paris-Descartes, Paris, France;1. Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan;2. Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan;1. Department of Urology, Mayo Clinic, Rochester, MN;2. Department of Surgery, Oncology and Gastroenterology – Urology, University of Padua, Padua, Italy;3. Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland |
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| Abstract: | ![]()
BackgroundWe tested for associations between socioeconomic status (SES) and adverse prostate cancer pathology in a population of African American (AA) men treated with radical prostatectomy (RP).Patients and MethodsWe retrospectively reviewed data from 2 institutions for AA men who underwent RP between 2010 and 2015. Household incomes were estimated using census tract data, and patients were stratified into income groups relative to the study population median. Pathologic outcomes after RP were assessed, including the postsurgical Cancer of the Prostate Risk Assessment (CAPRA-S) score and a definition of adverse pathology (stage ≥ pT3, Gleason score ≥ 4+3, or positive lymph nodes), and compared between income groups.ResultsWe analyzed data of 347 AA men. Median household income was $37,954. Low-SES men had significantly higher prostate-specific antigen values (mean 10.2 vs. 7.3; P < .01) and CAPRA-S scores (mean 3.4 vs. 2.5; P < .01), more advanced pathologic stage (T3-T4 31.8% vs. 21.5%; P = .03), and higher rates of seminal vesicle invasion (17.3% vs. 8.2%; P < .01), positive surgical margins (35.3% vs. 22.1%; P < .01), and adverse pathology (41.4% vs. 30.1%; P = .03). Linear and logistic regression showed significant inverse associations of SES with CAPRA-S score (P < .01) and adverse pathology (P = .03).ConclusionIn a population of AA men who underwent RP, we observed an independent association of low SES with advanced stage or aggressive prostate cancer. By including only patients in a single racial demographic group, we eliminated the potential confounding effect of race on the association between SES and prostate cancer risk. These findings suggest that impoverished populations might benefit from more intensive screening and early, aggressive treatment of prostatic malignancies. |
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| Keywords: | African American Disparities Poverty Prostatic neoplasms Race |
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