A population-based survey of prostate-specific antigen testing among California men at higher risk for prostate carcinoma

Prostate cancer incidence among immigrant men in Ontario, Canada: a population-based retrospective cohort study

BACKGROUND

Prostate cancer incidence has been associated with various sociodemographic factors, such as race, income and age, but the association with immigrant status in Canada is unclear. In this population-based study in Ontario, Canada, we compared age-standardized incidence rates for immigrant males from various regions of origin with the rates of long-term residents.

METHODS

In this retrospective cohort study, we linked several provincial-level databases available at ICES, an independent, non-profit research institute. We included all males aged 20 years and older in the province of Ontario eligible for health care for each fiscal year (Apr. 1 to Mar. 31) in 2008-2016. We determined age-standardized prostate cancer incidence rates, stratifying by immigrant status (a binary variable) and region of origin. We used a log-binomial model to estimate adjusted incidence rate ratios, with long-term residents (Canadian-born Ontarians as well as those who immigrated before 1985, when available data on immigration starts) as the reference group. We included age, neighbourhood income and time since landing in the models. Additional models limited to immigrant males in the cohort included immigration admission category (economic class, family class, refugee, other) and time since landing in Canada.

RESULTS

There were 74594 incident cases of prostate cancer in the study period, 6742 of which were among immigrant males. Males who had immigrated from West Africa and the Caribbean had significantly higher incidence of prostate cancer than other immigrants and long-term residents: adjusted rate ratios of 2.71 (95% confidence interval [CI] 2.41-3.05) and 1.91 (95% CI 1.78-2.04), respectively. Immigrants from other regions, including East Africa and Middle-Southern Africa, had lower or similar incidence rates to long-term residents. Males from South Asia had the lowest adjusted rate ratio (0.47, 95% CI 0.45-0.50).

INTERPRETATION

The age-standardized incidence rate of prostate cancer from 2008 to 2016 was consistently and significantly higher among immigrants from West African and Caribbean countries than among other immigrants and long-term residents of the province. Future research in Canada should focus on further understanding heterogeneity in prostate cancer risk and epidemiology, including stage of diagnosis and mortality, for immigrants.

Caring for the Uninsured with Prostate Cancer: A Comparison of Four Policy Alternatives in California

The IMPACT Program seeks to improve access to prostate cancer care for low-income, uninsured men. The objective of the current study was to compare the cost-effectiveness of four policy alternatives in treating this population. We analyzed the cost-effectiveness of four policy alternatives for providing care to low-income, uninsured men with prostate cancer: (1) IMPACT as originally envisioned, (2) a version of IMPACT with reduced physician fees, (3) a hypothetical Medicaid prostate cancer treatment program, and (4) the existing county safety net. We calculated cost-effectiveness based on incremental cost-effectiveness ratios (ICERs) with the formula ICER = (Cost(alternative strategy) - Cost(baseline strategy)) / (QALY(alternative strategy) - QALY(baseline strategy)). We measured outcomes as quality-adjusted life years (QALYs). "Best-case" scenarios assumed timely access to care in 50% of cases in the county system and 70% of cases in any system that reimbursed providers at Medicaid fee-for-service rates. "Worst-case" scenarios assumed timely access in 35 and 50% of corresponding cases. In fiscal year 2004-2005, IMPACT allocated 11% of total expenditures to administrative functions and 23% to fixed clinical costs, with an overall budget of $5.9 million. The ICERs ($/QALY) assuming "best-case" scenarios for original IMPACT, modified IMPACT, and a hypothetical Medicaid program were $32,091; $64,663; and $10,376; respectively. ICERs assuming "worst-case" scenarios were $27,189; $84,236; and $10,714; respectively. County safety net was used as a baseline. In conclusion, IMPACT provides underserved Californians with prostate cancer care and value-added services with only 11% of funds allocated to administrative fixed costs. Both the original IMPACT program and the hypothetical Medicaid prostate cancer program were cost-effective compared to the county safety net, while the reduced-fees version of IMPACT was not.

Prostate Cancer Screening in Jamaica: Results of the Largest National Screening Clinic

Prostate cancer is highly prevalent in Jamaica and is the leading cause of cancer-related deaths. Our aim was to evaluate the patterns of screening in the largest organized screening clinic in Jamaica at the Jamaica Cancer Society. A retrospective analysis of all men presenting for screening at the Jamaica Cancer Society from 1995 to 2005 was done. All patients had digital rectal examinations (DRE) and prostate specific antigen (PSA) tests done. Results of prostate biopsies were noted. 1117 men of mean age 59.9 ± 8.2 years presented for screening. The median documented PSA was 1.6 ng/mL (maximum of 5170 ng/mL). Most patients presented for only 1 screen. There was a gradual reduction in the mean age of presentation for screening over the period. Prostate biopsies were requested on 11% of screening visits; however, only 59% of these were done. 5.6% of all persons screened were found to have cancer. Of the cancers diagnosed, Gleason 6 adenocarcinoma was the commonest grade and median PSA was 8.9 ng/mL (range 1.5-1059 ng/mL). Older men tend to screen for prostate cancer in Jamaica. However, compliance with regular maintenance visits and requests for confirmatory biopsies are poor. Screening needs intervention in the Jamaican population.

Racial differences in time from prostate cancer diagnosis to treatment initiation: a population-based study

BACKGROUND

Timely delivery of care has been identified by the Institute of Medicine as an indicator for quality health care, and treatment delay is a potentially modifiable obstacle that can contribute to the disparities among African American (AA) and Caucasian patients in prostate cancer recurrence and mortality. Using the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database, we compared time from diagnosis to treatment in AA and Caucasian prostate cancer patients.

METHODS

A total of 2506 AA and 21,454 Caucasian patients diagnosed with localized prostate cancer from 2004 through 2007 and treated within 12 months were included. Linear regression was used to assess potential differences in time to treatment between AA and Caucasian patients, after adjusting for sociodemographic and clinical covariates.

RESULTS

Time from diagnosis to definitive (prostatectomy and radiation) treatment was longer for AA patients in all risk groups, and most pronounced in high-risk cancer (96 versus 105 days, P < .001). On multivariate analysis, racial differences to any and definitive treatment persisted (β = 7.3 and 7.6, respectively, for AA patients). Delay to definitive treatment was longer in high-risk (versus low-risk) disease and in more recent years.

CONCLUSIONS

AA patients with prostate cancer experienced longer time from diagnosis to treatment than Caucasian patients with prostate cancer. AA patients appear to experience disparities across all aspects of this disease process, and together these factors in receipt of care plausibly contribute to the observed differences in rates of recurrence and mortality among AA and Caucasian patients with prostate cancer.

Factors Associated With Cancer Family History Communication Between African American Men and Their Relatives

African American men bear a disproportionately high burden from cancer in the U.S. The American Cancer Society reports that for all cancer sites combined, African American men are 32% more likely to die than white men (American Cancer Society, 2011). Having a family history of cancer elevates an individual's risk for the disease and should inform decision-making around the use of specific cancer screening tests as well as earlier onset and frequency of cancer screening. Adult African American men who attended an annual hospital-based community health fair in the Midwest which targeted minority men, were approached to complete a paper-based survey. Participants were asked "have you ever talked with any of your relatives about your family history of cancer (about any members of your family who have been diagnosed with cancer)?" Predictors were evaluated using bivariate analysis and logistic regression; they included socio-demographic, health access, health behavior, health status, and communication variables. Participants were 558 African American men with a mean age of 54 years old. African American men were most likely to have ever discussed their family history of cancer with a relative if they had specific knowledge of their family history of cancer and if they had ever talked to a physician about their family history of cancer. For African American men with a familial predisposition to cancer, further examination of barriers and facilitators to discussion with relatives, specifically those related to health access and knowledge, is warranted.

A prospective study of socioeconomic status, prostate cancer screening and incidence among men at high risk for prostate cancer

PURPOSE

Higher socioeconomic status (SES) men are at higher risk of prostate cancer (PCa) diagnosis, an association commonly interpreted as a function of higher rates of prostate screening among higher SES men. However, the extent to which screening explains this association has not been well quantified.

METHODS

Within a Detroit area cohort of 6,692 men followed up after a benign prostate procedure, a case-control study was conducted of 494 PCa cases and controls matched on age, race, duration of follow-up, and date of initial benign finding; 2000 Census data were used in a principal component analysis to derive a single factor, labeled the neighborhood SES index (NSESI), representing zip code-level SES.

RESULTS

Among cases, higher SES was associated with a younger age at initial biopsy: -1.48 years (95 % CI, -2.32, -0.64) per unit NSESI. After adjustment for confounders and duration of follow-up, higher SES was associated with more PSA tests and DRE during follow-up; 9 % (95 % CI, 2, 16) and 8 % (95 % CI, 1, 15) more respectively, per unit NSESI. Higher SES was associated with a higher risk of PCa diagnosis during follow-up, multivariable adjusted OR = 1.26 per unit increase in NSESI (95 % CI, 1.04, 1.49). Further adjustment for screening frequency somewhat reduced the association between SES and PCa risk (OR = 1.19 per unit NSESI, 95 % CI, 0.98, 1.44).

CONCLUSIONS

Differences in screening frequency only partially explained the association between higher zip code SES and PCa risk; other health care-related factors should also be considered as explanatory factors.

Association between family history of prostate cancer and positive biopsies in a Brazilian screening program

PURPOSE

To test the association between family history of prostate cancer (FH) and prostate cancer (PCa) risk in a large screening program in Brazil, as no conclusive study has yet investigated this.

METHODS

Between 2004 and 2007, 17,569 men were screened in 231 small municipalities using mobile screening units. Positive FH was defined as any relative having PCa among screened men. Men were biopsied if they had digital rectal examination suggestive of PCa or PSA >4.0 ng/mL or PSA of 2.5-4 ng/mL with percent free PSA ≤ 15 %. We analyzed the association between FH and PCa using multivariable logistic regression in the first screening round of the program.

RESULTS

Positive FH was present in 735 men (4.2 % of total), and they were younger, better educated and more likely to have had previous PCa screening (41.5 vs. 28.5 %; P < 0.001) compared to men with negative FH. FH status did not affect compliance rates in men recommended to undergo biopsy (P = 0.94). In first round, PCa was detected in 3.1 % of screened men (n = 552). In multivariable analysis, positive FH was associated with increased PCa risk (OR = 1.79; 95 % CI, 1.21-2.65; P = 0.003). However, Gleason scores (P = 0.78) or percent of positive cores (P = 0.32) among men with positive biopsies were similar, regardless of FH status.

CONCLUSIONS

In Brazil, men with positive FH were at increased PCa risk, which could not be explained by differential biopsy rates. This finding suggests that FH is also a true PCa risk factor in Brazil, a country with highly diverse population in terms of race, ethnicity, culture and socioeconomic status.

Association of healthcare barriers with prostate-specific antigen screening among African-American and Afro-Caribbean men

OBJECTIVE

To evaluate the association between the barriers to healthcare access and prostate-specific antigen (PSA) screening practices among African-American and Afro-Caribbean men.

METHODS

Stratified cluster sampling of census tracts in Brooklyn, New York yielded 533 men, aged 45-70 years. The men were classified into the following groups: U.S.-born white, U.S.-born African-American, Jamaican, and Trinidadian/Tobagonian. The subjects completed a written 6-item survey assessing the healthcare barriers.

RESULTS

Overall, 27% of men reported never having had a PSA test and 28% reported that they had received annual PSA screening. On multivariate analysis, those who viewed the healthcare system as convenient were more likely to report an initial PSA test (odds ratio 1.8, P < .05). Those who perceived difficulty in accessing reliable care were less likely to ever have had a PSA test (odds ratio 0.6, P < .05). Subjects who had not had a comprehensive discussion with their physician about prostate cancer were less likely to have had an initial PSA test and more likely to have maintained annual PSA screening (odds ratio 0.3 and 1.7, respectively, P < .05).

CONCLUSION

We identified 2 novel perceived barriers to prostate cancer screening: men who experience the healthcare system as inconvenient were less likely to initiate PSA testing, and those who found it difficult to obtain quality care were less likely to ever have had a PSA test. The perceived system barriers were more closely linked to PSA screening behavior than were the measures assessing perceptions of self-efficacy. Our results suggest that a broader discussion by physicians that addresses the perceptions regarding the healthcare system might enhance the understanding of, and increase the use of, prostate cancer screening among higher risk minority men.

A community-driven intervention for prostate cancer screening in African Americans

The purpose of the study was to assess the impact of an educational intervention on prostate cancer screening behavior and knowledge. Participants were 104 African American men, 45 years and older, who had not been screened for prostate cancer with a prostate-specific antigen and/or digital rectal exam within the past year. All participants received an intervention delivered by trained lay community educators using a prostate cancer educational brochure developed in collaboration with the community, with structured interviews preintervention and 3 months postintervention. The main study outcomes included prostate-specific antigen screening rates during the 3-month interval and knowledge, barriers to screenings, and decisional conflict around screening. Compared with the 46 men who did not get screened, the 58 participants who got screened were more likely to have greater than a high school education, annual household incomes ≥$25,000, and a family history of non-prostate cancer (p < .05). Average knowledge scores increased, and barriers to screening scores decreased, from preintervention to postintervention only for participants who had been screened (p < .05). The results of this study demonstrate the feasibility and efficacy of an academic institution collaborating with the African American community to develop a successful prostate cancer educational intervention, an approach that can be expanded to other cancers and other chronic diseases.

Barriers and facilitators to digital rectal examination screening among African-American and African-Caribbean men

OBJECTIVES

To examine the effect of race/ethnicity and fear characteristics on the initiation and maintenance of digital rectal examination (DRE) screening.

METHODS

A total of 533 men from Brooklyn, New York, aged 45-70 years, were classified into 4 race/ethnic groups: U.S.-born whites, U.S.-born African-American, Jamaican, and Trinidadian/Tobagonian. The participants recorded the number of DREs in the past 10 years. The demographics and structural variables and prostate cancer worry and screening fear were measured using validated tools.

RESULTS

Overall, 30% of subjects reported never having a DRE, and 24% reported annual DREs. African-American, Jamaican, and Trinidadian/Tobagonian men had greater prostate cancer worry and screening fear scores than did the white men (all P < .05). African-American, Jamaican, and Trinidadian/Tobagonian men were less likely to maintain annual DREs than white men (odds ratio 0.17, 0.26, and 0.16, respectively, all P < .05). The men with low screening fear were more likely to have had an initial DRE (OR 2.3, P < .05 vs high screening fear) but were no more or less likely to undergo annual DREs. Having a regular physician, comprehensive physician discussion, and annual visits were also associated with undergoing DREs.

CONCLUSIONS

We identified several ethnically varying barriers and facilitators to DRE screening. African-American and African-Caribbean men undergo DRE less often and have greater prostate cancer worry and screening fear scores than did white men. Screening fear predicts the likelihood of undergoing an initial, but not annual, DRE screening. Access to a physician and annual visits facilitate DRE screening. Interventions that include both culturally sensitive education and patient navigation and considered whether patients should be initiating or maintaining screening might facilitate guideline-consistent screening.

Fatores associados à realização dos exames de rastreamento para o câncer de próstata: um estudo de base populacional

O objetivo deste estudo foi analisar a prevalência da realização dos exames de rastreamento para o câncer de próstata em homens com 50 anos ou mais de idade, segundo variáveis socioeconômicas, demográficas, de comportamentos relacionados à saúde e presença de morbidade. O estudo foi do tipo transversal, de base populacional, e as análises estatísticas consideraram o delineamento da amostra. Os fatores associados à não realização dos exames de rastreamento do câncer de próstata, foram: ter de idade menor que 70 anos, ter escolaridade de até 8 anos, renda familiar per capita menor que 0,5 salário mínimo, não ter diabetes, ter limitação visual e não ter ido ao dentista no último ano. O SUS foi responsável pela realização de 41% dos exames de rastreamento do câncer de próstata referidos. Este estudo apontou que apesar da controvérsia sobre e efetividade do toque retal e da dosagem do Antígeno Específico Prostático (PSA) para a detecção do câncer de próstata, parcela significativa da população masculina vem realizando estes exames para os quais existem significativas desigualdades socioeconômicas quanto ao acesso.

A review of prostate-specific antigen screening prevalence and risk perceptions for first-degree relatives of men with prostate cancer

First-degree relatives of men with prostate cancer have a higher risk of being diagnosed with prostate cancer than men without a family history. The present review examines the prevalence and predictors of testing in first-degree relatives, perceptions of risk, prostate cancer knowledge and psychological consequences of screening. Medline, PsycInfo and Cinahl databases were searched for articles examining risk perceptions or screening practices of first-degree relatives of men with prostate cancer for the period of 1990 to August 2007. Eighteen studies were eligible for inclusion. First-degree relatives participated in prostate-specific antigen (PSA) testing more and perceived their risk of prostate cancer to be higher than men without a family history. Family history factors (e.g. being an unaffected son rather than an unaffected brother) were consistent predictors of PSA testing. Studies were characterized by sampling biases and a lack of longitudinal assessments. Prospective, longitudinal assessments with well-validated and comprehensive measures are needed to identify factors that cue the uptake of screening and from this develop an evidence base for decision support. Men with a family history may benefit from targeted communication about the risks and benefits of prostate cancer testing that responds to the implications of their heightened risk.

Is social support from family associated with PSA testing? An exploratory analysis using the Health Information National Trends Survey (HINTS) 2005

African American and White men have the highest rates of prostate cancer in the United States. Families represent important social contexts within which illness occurs.The purpose of this study is to explore whether prostate-specific antigen (PSA) testing is associated with instrumental and informational social support from family members among a sample of Black and White men aged 45 and older. Data from the 2005 Health Information National Trends Survey were analyzed using logistic regression. The dependent variable was having a PSA test within the past year or less. The independent variables consisted of selected demographic and family informational and instrumental social support variables. The statistically significant variables included age and having a family member with cancer. Additional studies to elucidate the mechanisms of social support from family for prostate cancer are needed.

Prostate cancer early detection program recruitment methods and show rates in men at high risk

PURPOSE

Men with a family history of prostate cancer and black men are at higher risk for prostate cancer. Recruitment and retention of these men at high risk into early detection programs is challenging. We report a comprehensive analysis of recruitment methods, show rates and participant factors from the Prostate Cancer Risk Assessment Program, a prospective, longitudinal prostate cancer screening study.

MATERIALS AND METHODS

Men 35 to 69 years old were eligible for recruitment if they had a family history of prostate cancer, were black or had a BRCA1/2 mutation. Recruitment methods were analyzed using standard statistical methods with respect to participant demographics and presentation to the first program appointment.

RESULTS

Of 707 men recruited 64.9% presented to the initial program appointment. More men were recruited via radio than via referral or other methods (chi-square = 298.13, p <0.0001). Men recruited by radio were more likely to be black (p <0.001), less educated (p = 0.003) and not married or partnered (p = 0.007), and have no prostate cancer family history (p <0.001). Men recruited by referral had a higher income (p = 0.007) and were more likely to attend the initial program visit than those recruited by radio or other methods (chi-square = 27.08, p <0.0001).

CONCLUSIONS

This comprehensive analysis shows that radio led to higher recruitment of black men with lower socioeconomic status. However, these men at high risk have a lower presentation rate for prostate cancer screening. Targeted motivational measures must be studied to improve the show rate for prostate cancer risk assessment in these men at high risk.

Rates and sociodemographic correlates of cancer screening among South Asians

Although the third largest Asian subgroup in the U.S., South Asians have rarely been included in cancer research. The purpose of this study was to assess rates and correlates of cancer screening in a community sample of South Asians. This study was a collaboration between the UCLA School of Public Health and South Asian Network (SAN), a social service organization in Southern California. Data were collected from 344 adults including a substantial portion of immigrants and individuals with low income and education. Few participants received screening within guidelines for colorectal (25%), breast (34%), cervical (57%) and prostate cancer (10%). Health insurance, younger age and increased length of stay in the U.S. predicted a higher likelihood of cancer screening. Women were significantly less likely to have received colorectal cancer screening compared to men. These results will guide SAN's program planning efforts. Future interventions should focus on increasing cancer screening in this population.

Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California

Background

The racial/ethnic disparities in prostate cancer rates are well documented, with the highest incidence and mortality rates observed among African-Americans followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders. Whether socioeconomic status (SES) can account for these differences in risk has been investigated in previous studies, but with conflicting results. Furthermore, previous studies have focused primarily on the differences between African-Americans and non-Hispanic Whites, and little is known for Hispanics and Asian/Pacific Islanders.

Objective

To further investigate the relationship between SES and prostate cancer among African-Americans, non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders, we conducted a large population-based cross-sectional study of 98,484 incident prostate cancer cases and 8,997 prostate cancer deaths from California.

Methods

Data were abstracted from the California Cancer Registry, a population-based surveillance, epidemiology, and end results (SEER) registry. Each prostate cancer case and death was assigned a multidimensional neighborhood-SES index using the 2000 US Census data. SES quintile-specific prostate cancer incidence and mortality rates and rate ratios were estimated using SEER*Stat for each race/ethnicity categorized into 10-year age groups.

Results

For prostate cancer incidence, we observed higher levels of SES to be significantly associated with increased risk of disease [SES Q1 vs. Q5: relative risk (RR) = 1.28; 95% confidence interval (CI): 1.25–1.30]. Among younger men (45–64 years), African-Americans had the highest incidence rates followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders for all SES levels. Yet, among older men (75–84 years) Hispanics, following African-Americans, displayed the second highest incidence rates of prostate cancer. For prostate cancer deaths, higher levels of SES were associated with lower mortality rates of prostate cancer deaths (SES Q1 vs. Q5: RR = 0.88; 95% CI: 0.92–0.94). African-Americans had a twofold to fivefold increased risk of prostate cancer deaths in comparison to non-Hispanic Whites across all levels of SES.

Conclusions

Our findings suggest that SES alone cannot account for the greater burden of prostate cancer among African-American men. In addition, incidence and mortality rates of prostate cancer display different age and racial/ethnic patterns across gradients of SES.

Electronic supplementary material

The online version of this article (doi:10.1007/s10552-009-9369-0) contains supplementary material, which is available to authorized users.

Prostate cancer severity among low income, uninsured men

PURPOSE

The proportion of American men with organ confined, low risk prostate cancer has increased significantly during the last 2 decades. Whether this trend also applies to men at the extremes of socioeconomic disadvantage remains unknown. Therefore, we evaluated trends in prostate cancer severity in an ethnically diverse cohort of low income, uninsured men served by a state funded public health program in California.

MATERIALS AND METHODS

We performed a retrospective cohort study of 570 disadvantaged men enrolled in the California program from 2001 through 2006. Using routinely collected clinical variables we defined 2 measures of cancer severity as 1) the proportion of enrollees with metastases at diagnosis and 2) the proportions of men with nonmetastatic tumors whose cancers had low, intermediate or high risk features at diagnosis. We performed bivariate analyses to assess time trends in cancer severity.

RESULTS

Prostate specific antigen levels at diagnosis exceeded 10 ng/ml for 51% of enrollees, 50% had a Gleason score 7 or greater and 43% had clinical T stage T2 or greater. Of disadvantaged men 19% had metastatic cancer at diagnosis and this proportion remained stable over time (p = 0.66). Among men with nonmetastatic cancers 24% had tumors with low risk features and the proportion of low risk cancers did not increase over time (p = 0.34).

CONCLUSIONS

Unlike the broader United States population the proportion of disadvantaged men with organ confined, low risk prostate cancer has not been increasing. Thus, while much attention focuses on potential overdiagnosis and overtreatment of men with screen detected prostate cancer, our findings suggest that for low income, uninsured men, underdetection and undertreatment remain significant concerns.

Racial disparities in access to care for men in a public assistance program for prostate cancer

California's IMPACT program provides all its enrollees with health insurance and social service resources. We hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Our objective was to evaluate racial/ethnic differences in health services utilization and patient-reported health care outcomes among disadvantaged men in a prostate cancer public-assistance program, and to identify modifiable factors that might explain persistent disparities in this health care setting. We performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. We evaluated realized access to care with two health services utilization measures: (1) use of emergency department care without hospitalization and, (2) frequency of prostate-specific antigen testing. We also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. We observed significant bivariate associations between race/ethnicity and patient-experience outcomes (P<0.05), but not utilization measures. In multivariable models, Hispanic men were more likely than white men to report complete satisfaction with health care received in IMPACT (adjusted OR=5.15, 95% CI 1.17-22.6); however, the association between race/ethnicity and satisfaction was not statistically significant (P=0.11). Language preference and self-efficacy in patient-physician interactions are potentially-modifiable predictors of patient-experience outcomes. We observed no racial/ethnic disparities in health services utilization among disadvantaged men served by a disease-specific public assistance program. The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement.

Prostate-specific antigen screening among young men in the United States

BACKGROUND

Disagreement exists on the use of prostate-specific antigen (PSA) tests for cancer-risk stratification in young men in the United States. Little is known about the use of PSA testing in these men. To understand policy implications of risk stratification, the authors sought to characterize PSA use among young men.

METHODS

The authors used the 2002 Behavioral Risk Factor Surveillance System to study prostate-cancer screening in a representative sample of men aged 40 years and older (n = 58,511). The primary outcome was self-report of a PSA test in the previous year.

RESULTS

Among men aged 40 to 49 years, 22.5% (95% confidence interval [CI], 21.5-23.5) reported having had a PSA test in the previous year, compared with 53.7% (95% CI, 52.8-54.7; P < .001) of men aged >or=50 years. When sociodemographic characteristics were statistically controlled, young, black, non-Hispanic men were more likely than young, white, non-Hispanic men to report having had a PSA test in the previous year (odds ratio [OR], 2.42; 95% CI, 1.95-3.01; P < .001). In young men, annual household income >or=USD 35,000 (OR, 1.50; 95% CI, 1.26-1.78; P < .001) and an ongoing relationship with a physician (OR, 2.52; 95% CI, 2.06-3.07; P < .001) were associated with PSA testing.

CONCLUSIONS

One-fifth of young men reported having had a PSA test within the previous year. Young, black, non-Hispanic men are more likely than young, white, non-Hispanic men to report having had a PSA test, although screening in this high-risk group remains suboptimal.

Height and prostate cancer risk: a large nested case-control study (ProtecT) and meta-analysis

BACKGROUND

Height, a marker of childhood environmental exposures, is positively associated with prostate cancer risk, perhaps through the insulin-like growth factor system. We investigated the relationship of prostate cancer with height and its components (leg and trunk length) in a nested case-control study and with height in a dose-response meta-analysis.

METHODS

We nested a case-control study within a population-based randomized controlled trial evaluating treatments for localized prostate cancer in British men ages 50 to 69 years, including 1,357 cases detected through prostate-specific antigen testing and 7,990 controls (matched on age, general practice, assessment date). Nine bibliographic databases were searched systematically for studies on the height-prostate cancer association that were pooled in a meta-analysis.

RESULTS

Based on the nested case-control, the odds ratio (OR) of prostate-specific antigen-detected prostate cancer per 10 cm increase in height was 1.06 [95% confidence interval (95% CI): 0.97-1.16; p(trend) = 0.2]. There was stronger evidence of an association of height with high-grade prostate cancer (OR: 1.23; 95% CI: 1.06-1.43), mainly due to the leg component, but not with low-grade disease (OR: 0.99; 95% CI: 0.90-1.10). In general, associations with leg or trunk length were similar. A meta-analysis of 58 studies found evidence that height is positively associated with prostate cancer (random-effects OR per 10 cm: 1.06; 95% CI: 1.03-1.09), with a stronger effect for prospective studies of more advanced/aggressive cancers (random-effects OR: 1.12; 95% CI: 1.05-1.19).

CONCLUSION

These data indicate a limited role for childhood environmental exposures-as indexed by adult height-on prostate cancer incidence, while suggesting a greater role for progression, through mechanisms requiring further investigation.

Personal factors affecting African-American men's prostate cancer screening behavior

PURPOSE

Although there are significant controversies about prostate cancer screening, it is the only method recognized to combat prostate cancer through early detection and appropriate treatment. The primary goal of this study was to identify personal factors influencing African-American men's participation in prostate cancer screening.

METHODS

Two cross-sectional mail surveys were conducted over one year to test the validity of the Attitude-Social Influence-Efficacy model in predicting prostate cancer screening. Data were collected from African-American men age > or =40. The study hypotheses were tested using multiple linear regression and logistic regression analyses

RESULTS

One-hundred-ninety-one African-American men participated in the first cross-sectional survey, and 65 African-American men responded to the follow-up survey a year later. The participants were mostly African-American men who were born and grew up in America, were 50-59 years of age, had some college training, were married, were urban residents, had full-time employment status and had a household income of $20,000-$39,000. The key determinants of intention to undergo prostate cancer screening were attitude, perceived behavioral control, past behavior and perceived susceptibility. Attitude was the primary determinant of screening behavior.

CONCLUSION

To foster appropriate prostate cancer detection activities, the modifiable factors identified in this study should be considered.

Health risk behaviors and prostate specific antigen awareness among men in California

PURPOSE

Differences in prostate specific antigen awareness may contribute to differences in the frequency of prostate specific antigen testing. We investigated the association of health risk behaviors, including smoking, physical inactivity, obesity and excessive alcohol consumption, with awareness of the prostate specific antigen test in men in California at risk for prostate cancer.

MATERIALS AND METHODS

Using 2003 data from the California Health Interview Survey, a population based, random digit dial telephone survey, the records of 7,297 men 50 years or older without a history of prostate cancer were identified. The outcome was self-reported awareness of the prostate specific antigen test. The main independent variables were smoking status, physical activity level, body mass index and alcohol consumption. The prevalence, OR and 95% CI for prostate specific antigen awareness were calculated using SUDAAN to account for the complex sampling design.

RESULTS

The overall prevalence of prostate specific antigen awareness was 73.0%. After controlling for potential confounders the odds of being aware of the prostate specific antigen test was lower in current smokers (vs never smoked OR 0.53, 95% CI 0.41-0.68), physically inactive men (vs physically active OR 0.77, 95% CI 0.63-0.93) and obese men (vs normal weight OR 0.77, 95% CI 0.62-0.95).

CONCLUSIONS

Health risk behaviors are associated with lower prostate specific antigen awareness. Our findings suggest opportunities for focused health education interventions and quality improvement programs tailored to men who engage in unhealthy behaviors to improve their prostate specific antigen test awareness.

Racial differences in prostate cancer screening by family history

PURPOSE

Prostate cancer (CaP) is disproportionately prevalent among black, compared to white, men. Additionally, men with a family history of CaP have 75% to 80% higher risk of CaP. Therefore we examined racial variation in the association of family history of CaP and self-reported prostate-specific antigen (PSA) testing in the nationally-representative National Health Interview Survey (NHIS).

METHODS

Data were obtained from the 2005 NHIS, including the Cancer Control Module supplement. We restricted the study sample to men over the age of 40 who reported having "ever heard of a PSA test" (N = 1,744). Men were considered to have a positive family history if either their biological father or at least one biological brother had been diagnosed with CaP. SUDAAN 9.0 was used to perform descriptive and multivariable logistic regression analyses.

RESULTS

Men with a family history of CaP were more likely to have a PSA test than those who never had a PSA test (odds ratio [OR] = 1.8; 95% confidence interval [CI]: 1.3-2.5). Among blacks, men with a family history were not significantly more likely to have a PSA test.

CONCLUSIONS

Despite having the highest risk of cancer, black men with a family history are not screened more than black men without a family history.

Health status and behavioral risk factors among persons with epilepsy in Ohio based on the 2006 Behavioral Risk Factor Surveillance System

In 2006, Ohio added questions to the Centers for Disease Control and Prevention's yearly Behavioral Risk Factor Surveillance System (BRFSS) survey to assess epilepsy prevalence. Ninety-seven of 5506 respondents reported a history of epilepsy, yielding a weight-adjusted prevalence rate of 1.48% (95% CI=0.9-2.1), which is supportive of previous state-based epidemiology estimates. Persons with a history of epilepsy report double the rate of cigarette smoking than the population without epilepsy. Persons with both active epilepsy and a history of epilepsy report poor physical and mental health. Health screening behaviors were comparable to or higher than those of the population without epilepsy. Data from previous BRFSS surveys are used to identify major risk factor trends, as well as to explore the health promotion implications for people with epilepsy. Assessments reveal a need for smoking cessation and increased physical activity for persons with a history of epilepsy in Ohio.

Risk factors for prostate cancer in men aged less than 60 years: a case-control study from Italy

OBJECTIVES

To analyze the relationship between selected risk factors and prostate cancer risk in men younger than 60 years, using data from a large, multicenter, case-control study conducted in Italy.

METHODS

Cases were 219 patients, aged 45 to 59 years, with histologically confirmed prostate cancer, and controls were 431 men of the same age group, admitted in hospital for acute, non-neoplastic diseases.

RESULTS

A family history of prostate cancer (odds ratio [OR] = 5.5), brain cancer (OR = 3.7), and leukemia (OR = 6.2) were associated with prostate cancer risk. A significantly increased risk was found for high education level (OR = 3.3 for 12 or more years versus less than 7 years) and a decreased risk for physical activity (OR = 0.5 for active versus inactive). Coffee consumption was directly associated with risk of prostate cancer (OR = 1.9 for the third versus the first tertile). Bread consumption was directly related (OR = 1.6) and consumption of raw and total vegetables inversely related (OR = 0.6) to prostate cancer risk, although these associations were of borderline significance. No association emerged with marital status, body mass index, history of diabetes, alcohol drinking, and other considered foods.

CONCLUSIONS

This study confirms that some recognized risk factors, including family history of prostate cancer, high level of education, and low physical activity, are associated with prostate cancer risk in middle-aged men.

Prostate cancer screening in men with a family history of prostate cancer: the role of partners in influencing men's screening uptake

OBJECTIVE

To assess the role of the partners, as well as other sociodemographic and psychological factors, in influencing prostate cancer screening uptake among men with a family history of prostate cancer.

METHODS

This was a cross-sectional study of 280 unaffected men with a family history of prostate cancer along with 174 of their partners, using mailed, self-administered questionnaires.

RESULTS

The majority of respondents reported having had at least one prostate-specific antigen (PSA) test (78.9%) and/or one digital rectal examination (DRE) (78.0%). Ever having had a PSA test was associated with number of first- and second-degree relatives with prostate cancer (odds ratio [OR] = 1.79; 95% confidence interval [CI] 1.03 to 3.11; P = 0.040) and relationship status. Compared with men who were single, those with partners with high involvement in men's screening had a significantly higher uptake of PSA screening (OR = 3.41; 95% CI 1.12 to 10.44; P = 0.031). Ever having had a DRE was significantly and positively associated with age (OR = 1.09; 95% CI 1.05 to 1.13; P <0.001) and perceived prostate cancer risk (OR = 1.03; 95% CI 1.01 to 1.04; P <0.001), as well as having sons (OR = 2.06; 95% CI 1.06 to 3.97; P = 0.032).

CONCLUSIONS

Psychological factors are the most important influence on men's uptake of DRE, whereas external factors, including partner's involvement, influence PSA uptake. If prostate cancer screening is ultimately shown to be efficacious for men with a family history of prostate cancer, screening uptake will be maximized in this target group by enlisting the support of partners.

Increased cancer risk for individuals with a family history of prostate cancer, colorectal cancer, and melanoma and their associated screening recommendations and practices

Prostate cancer, colorectal cancer, and melanoma are three malignancies that appear to have strong genetic components that can confer additional risk to family members. Screening tools, albeit controversial, are widely available to potentially aide in early diagnosis. Family members are now more attuned to the risks and benefits of cancer screening, thus, it is imperative that physicians understand the screening tools and how to interpret the information they provide. We reviewed the current literature regarding the cancer risks for individuals with a family history of prostate cancer, colon cancer, and melanoma, the current screening recommendations for family members, and actual screening practices of individuals with a family history of these malignancies. This review should serve as a guide for physicians and cancer control planners when advising their patients and the public regarding screening decisions.

Race-specific geography of prostate cancer incidence

Background

This study evaluated geographic distribution of race-specific prostate cancer incidence in Connecticut and Massachusetts. This cross-sectional analysis of census and cancer registry data included records of 29,040 Whites and 1,647 African Americans diagnosed with incident prostate cancer between 1994 and 1998. A spatial scan statistic was used to detect and test significance of the geographic variation in race-specific incidence rates within the two-state area.

Results

Significant geographic variation in age-adjusted incidence rates among both White and African American men was observed, with little overlap noted between distributions. Identified locations reflected patterns of residential segregation and socio-economic conditions. Among Whites, places with higher than expected incidence had higher socioeconomic status than places with lower than expected incidence. No discernable relationship between social indicators and rate variation among African Americans was evident.

Conclusion

Differences in race-specific geographic distribution of prostate cancer incidence do not suggest a shared environmental etiology. Furtherstudyof genetic, behavioral and health carefactors affecting the occurrence and/or reporting of the disease is warranted. This study highlights the need for race- and geographic-specific interventions to better control disease within at-risk communities and for on-going analysis into social and contextual factors that contribute to observed disparities between African Americans and Whites in the occurrence of cancer.

Disparities in Colon Cancer Presentation and In-Hospital Mortality in Maryland: A Ten-Year Review

BACKGROUND

Much attention has focused on in-hospital treatment disparities in colon cancer outcomes. Little is known about the effect of prehospital factors on outcomes. We hypothesized that racial and socioeconomic disparities exist in the presentation of colon cancer and that these disparities affect in-hospital outcomes.

METHODS

Ten-year data on colon cancer patients were obtained from the Maryland Hospital Discharge Database. Life-threatening symptoms at presentation served as a proxy for delay in diagnosis. Patients with the primary diagnosis of colon cancer treated with surgical resection were included. Outcomes of interest were obstruction, hemorrhage, perforation, and in-hospital mortality.

RESULTS

A total of 14,291 patients had primary colon cancer, and 13,031 underwent resection. Among this group, 52% were male, 22% were African American (AA), and mean age of AA was 66.0 years versus non-AA mean age of 70.5 years (P < .001). Overall, 27.6% of patients presented with life-threatening symptoms. In-hospital mortality rate was 3.8%. Symptomatic patients had a 2-fold higher rate of in-hospital mortality (odds ratio [OR], 6.06 vs. 2.89, P < .001). Multivariate analysis demonstrated that AA were more likely to have life-threatening symptoms at presentation independent of socioeconomic status (SES) (OR, 1.36). In addition, AA had a higher in-hospital mortality, both overall (OR, 1.39) and in the higher SES (OR, 1.81).

CONCLUSIONS

Racial disparities exist in the rate of presentation with life-threatening symptoms that may be a proxy for a delay in diagnosis. These findings were independent of SES, implying that factors beyond health care access may account for poorer outcomes among AA.