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Ellis ET, Fairman BJ, Stahr SD, Bensen JT, Mohler JL, Song L, Butler EN, Su LJ, Hsu PC. Cigarette smoking and prostate cancer aggressiveness among African and European American men. Cancer Causes Control 2024:10.1007/s10552-024-01883-3. [PMID: 38758522 DOI: 10.1007/s10552-024-01883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Smoking is a modifiable lifestyle factor that has not been established as a prostate cancer risk factor, nor emphasized in prostate cancer prevention. Studies have shown that African American (AA) smokers have a poorer cancer prognosis than European Americans (EAs), while having a lower prevalence of heavy smoking. We examined the relationship between cigarette smoking and prostate cancer aggressiveness and assessed racial differences in smoking habits on the probability of high-aggressive prostate cancer. METHODS Using data from the North Carolina-Louisiana Prostate Cancer Project (n = 1,279), prostate cancer aggressiveness was defined as high or low based on Gleason scores, serum prostate-specific antigen levels, and tumor stage. Cigarette smoking was categorized as current, former, or never smokers. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS Self-reported current (OR = 1.99; 95% CI 1.30-3.06) smoking was associated with high-aggressive prostate cancer relative to never smokers. When stratified by self-reported race, the odds of having high-aggressive cancer increased among AA current (OR = 3.58; 95% CI 2.04-6.28) and former smokers (OR = 2.21; 95% CI 1.38-3.53) compared to AA never smokers, but the odds were diminished among the EA stratum (Pself-reported race x smoking status = 0.003). CONCLUSION Cigarette smoking is associated with prostate cancer aggressiveness, a relationship modulated by self-reported race. Future research is needed to investigate types of cigarettes smoked and metabolic differences that may be contributing to the racial disparities observed.
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Affiliation(s)
- Edgar T Ellis
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St., #820, Little Rock, AR, 72205-7190, USA
| | - Brian J Fairman
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Shelbie D Stahr
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St., #820, Little Rock, AR, 72205-7190, USA
| | - Jeannette T Bensen
- Lineberger Comprehensive Cancer Center and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Lixin Song
- School of Nursing & Mays Cancer Center, University of Texas Health Science Center San Antonio, San Antonio, TX, 78229, USA
| | - Eboneé N Butler
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - L Joseph Su
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Ping-Ching Hsu
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham St., #820, Little Rock, AR, 72205-7190, USA.
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Khan S, Fuzzell L, Langston M, Han Y, Moore JX, Gilbert K, Sutcliffe S, Bensen JT, Mohler JL, Fontham ETH, Song L, Lewis-Thames MW. The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer. Cancer Causes Control 2024; 35:531-539. [PMID: 37919455 PMCID: PMC11323108 DOI: 10.1007/s10552-023-01821-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort. METHODS The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer. RESULTS Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men. CONCLUSION Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.
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Affiliation(s)
- Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA.
- Epidemiology Program, College of Health Sciences, University of Delaware, 100 Discovery Blvd., 7th floor, Newark, DE, 19713, USA.
| | - Lindsay Fuzzell
- Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-COEE, Tampa, FL, 33612, USA
| | - Marvin Langston
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA
| | - Justin X Moore
- Center for Health Equity Transformation, Department of Behavioral Science, Department of Internal Medicine, Markey Cancer Center, University of Kentucky College of Medicine, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Keon Gilbert
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis, University, 3545 Lafayette Ave., Room 316, St. Louis, MO, 63103, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA
- Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, 4921 Parkview Place, St. Louis, MO, 63110, USA
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, 3130 Bioinformatics Building, CB# 7295, Chapel Hill, NC, 27599, USA
| | - James L Mohler
- Roswell Park Comprehensive Cancer Center, Elm and Carlton St, Buffalo, NY, 14263, USA
| | - Elizabeth T H Fontham
- Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, USA
| | - Lixin Song
- School of Nursing, University of North Carolina - Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr, Chicago, IL, 60611, USA
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Lin HY, Steck SE, Sarkar I, Fontham ETH, Diekman A, Rogers LJ, Ratliff CT, Bensen JT, Mohler JL, Su LJ. Interactions of SNPs in Folate Metabolism Related Genes on Prostate Cancer Aggressiveness in European Americans and African Americans. Cancers (Basel) 2023; 15:cancers15061699. [PMID: 36980585 PMCID: PMC10046243 DOI: 10.3390/cancers15061699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Studies showed that folate and related single nucleotide polymorphisms (SNPs) could predict prostate cancer (PCa) risk. However, little is known about the interactions of folate-related SNPs associated with PCa aggressiveness. The study’s objective is to evaluate SNP–SNP interactions among the DHFR 19-bp polymorphism and 10 SNPs in folate metabolism and the one-carbon metabolism pathway associated with PCa aggressiveness. Methods: We evaluated 1294 PCa patients, including 690 European Americans (EAs) and 604 African Americans (AAs). Both individual SNP effects and pairwise SNP–SNP interactions were analyzed. Results: None of the 11 individual polymorphisms were significant for EAs and AAs. Three SNP–SNP interaction pairs can predict PCa aggressiveness with a medium to large effect size. For the EA PCa patients, the interaction between rs1801133 (MTHFR) and rs2236225 (MTHFD1), and rs1801131 (MTHFR) and rs7587117 (SLC4A5) were significantly associated with aggressive PCa. For the AA PCa patients, the interaction of DHFR-19bp polymorphism and rs4652 (LGALS3) was significantly associated with aggressive PCa. Conclusions: These SNP–SNP interactions in the folate metabolism-related genes have a larger impact than SNP individual effects on tumor aggressiveness for EA and AA PCa patients. These findings can provide valuable information for potential biological mechanisms of PCa aggressiveness.
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Affiliation(s)
- Hui-Yi Lin
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Susan E. Steck
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Indrani Sarkar
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Elizabeth T. H. Fontham
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Alan Diekman
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Lora J. Rogers
- Winthrop P. Rockefeller Cancer Institute, Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Calvin T. Ratliff
- Winthrop P. Rockefeller Cancer Institute, Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Jeannette T. Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - James L. Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY 14203, USA
| | - L. Joseph Su
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Correspondence: ; Tel.: +1-214-648-6489
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Kc M, Oral E, Rung AL, Trapido E, Rozek LS, Fontham ETH, Bensen JT, Farnan L, Steck SE, Song L, Mohler JL, Khan S, Vohra S, Peters ES. Prostate cancer aggressiveness and financial toxicity among prostate cancer patients. Prostate 2023; 83:44-55. [PMID: 36063402 PMCID: PMC10087487 DOI: 10.1002/pros.24434] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/13/2022] [Accepted: 08/25/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Financial toxicity (FT) is a growing concern among cancer survivors that adversely affects the quality of life and survival. Individuals diagnosed with aggressive cancers are often at a greater risk of experiencing FT. The objectives of this study were to estimate FT among prostate cancer (PCa) survivors after 10-15 years of diagnosis, assess the relationship between PCa aggressiveness at diagnosis and FT, and examine whether current cancer treatment status mediates the relationship between PCa aggressiveness and FT. METHODS PCa patients enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP) were recontacted for long-term follow-up. The prevalence of FT in the PCaP cohort was estimated. FT was estimated using the COmprehensive Score for Financial Toxicity, a validated measure of FT. The direct effect of PCa aggressiveness and an indirect effect through current cancer treatment on FT was examined using causal mediation analysis. RESULTS More than one-third of PCa patients reported experiencing FT. PCa aggressiveness was significantly independently associated with high FT; high aggressive PCa at diagnosis had more than twice the risk of experiencing FT than those with low or intermediate aggressive PCa (adjusted odds ratio [aOR] = 2.13, 95% CI = 1.14-3.96). The proportion of the effect of PCa aggressiveness on FT, mediated by treatment status, was 10%, however, the adjusted odds ratio did not indicate significant evidence of mediation by treatment status (aOR = 1.05, 95% CI = 0.95-1.20). CONCLUSIONS Aggressive PCa was associated with high FT. Future studies should collect more information about the characteristics of men with high FT and identify additional risk factors of FT.
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Affiliation(s)
- Madhav Kc
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Evrim Oral
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Ariane L Rung
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Edward Trapido
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Elizabeth T H Fontham
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laura Farnan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Saira Khan
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Sanah Vohra
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edward S Peters
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, Louisiana, USA
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Khan S, Vohra S, Farnan L, Elmore SNC, Toumbou K, Madhav KC, Fontham ETH, Peters ES, Mohler JL, Bensen JT. Using health insurance claims data to assess long-term disease progression in a prostate cancer cohort. Prostate 2022; 82:1447-1455. [PMID: 35880605 PMCID: PMC9492636 DOI: 10.1002/pros.24418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-term population-based cohort studies of men diagnosed with prostate cancer are limited. However, adverse outcomes can occur many years after treatment. Herein, we aim to assess the utility of using claims data to identify prostate cancer progression 10-15 years after diagnosis. METHODS The study population was derived from the North Carolina-Louisiana Prostate Cancer Project (PCaP). PCaP-North Carolina (NC) included 1031 men diagnosed with prostate cancer from 2004 to 2009. An initial follow-up with a survey and manual medical record abstraction occurred from 2008 to 2011 (Follow-up 1). Herein, we extended this follow-up with linkage to healthcare claims data from North Carolina (2011-2017) and a second, supplementary 10-year follow-up survey (2018-2020) (Follow-up 2). Vital statistics data also were utilized. Long-term oncological progression was determined using these data sources in combination with expert clinical input. RESULTS Among the 1031 baseline PCaP-NC participants, 652 were linked to medical claims. Forty-two percent of the men had insurance coverage for the entire 72 months of follow-up. In addition, 275 baseline participants completed the supplementary 10-year follow-up survey. Using all sources of follow-up data, we identified a progression event in 259 of 1031 (25%) men with more than 10 years of follow-up data after diagnosis. CONCLUSIONS Understanding long-term clinical outcomes is essential for improving the lives of prostate cancer survivors. However, access and utility of long-term clinical outcomes with claims alone remain a challenge due to individualized agreements required with each insurer for data access, lack of detailed clinical information, and gaps in insurance coverage. We were able to utilize claims data to determine long-term progression due to several unique advantages that included the availability of detailed baseline clinical characteristics and treatments, detailed manually abstracted clinical data at 5 years of follow-up, vital statistics data, and a supplementary 10-year follow-up survey.
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Affiliation(s)
- Saira Khan
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Epidemiology Program, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Sanah Vohra
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shekinah N. C. Elmore
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Khadijah Toumbou
- Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - K. C. Madhav
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Elizabeth T. H. Fontham
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Edward S. Peters
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - James L. Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Jeannette T. Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Nyame YA, Cooperberg MR, Cumberbatch MG, Eggener SE, Etzioni R, Gomez SL, Haiman C, Huang F, Lee CT, Litwin MS, Lyratzopoulos G, Mohler JL, Murphy AB, Pettaway C, Powell IJ, Sasieni P, Schaeffer EM, Shariat SF, Gore JL. Deconstructing, Addressing, and Eliminating Racial and Ethnic Inequities in Prostate Cancer Care. Eur Urol 2022; 82:341-351. [PMID: 35367082 DOI: 10.1016/j.eururo.2022.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Men of African ancestry have demonstrated markedly higher rates of prostate cancer mortality than men of other races and ethnicities around the world. In fact, the highest rates of prostate cancer mortality worldwide are found in the Caribbean and Sub-Saharan West Africa, and among men of African descent in the USA. Addressing this inequity in prostate cancer care and outcomes requires a focused research approach that creates durable solutions to address the structural, social, environmental, and health factors that create racial disparities in care and outcomes. OBJECTIVE To introduce a conceptual model for evaluating racial inequities in prostate cancer care to facilitate the development of translational research studies and interventions. EVIDENCE ACQUISITION A collaborative review of literature relevant to racial inequities in prostate cancer care and outcomes was performed. Existing literature was used to highlight various components of the conceptual model to inform future research and interventions toward equitable care and outcomes. EVIDENCE SYNTHESIS Racial inequities in prostate cancer outcomes are driven by a series of structural and social determinants of health that impact exposures, mediators, and outcomes. Social determinants of equity, such as laws/policies, economic systems, and structural racism, affect the inequitable access to environmental and neighborhood exposures, in addition to health care access. Although the incidence disparity remains problematic, various studies have demonstrated parity in outcomes when social and health factors, such as access to equitable care, are normalized. Few studies have tested interventions to reduce inequities in prostate cancer among Black men. CONCLUSIONS Worldwide, men of African ancestry demonstrate worse outcomes in prostate cancer, a phenomenon driven largely by social factors that inform biologic, environmental, and health care risks. A conceptual model was presented that organizes the many factors that influence prostate cancer incidence and mortality. Within that framework, we must understand the current state of inequities in clinical prostate cancer practice, the optimal state of what equitable practice would be, and how achieving equity in prostate cancer care balances costs, benefits, and harms. More robust characterization of the sources of prostate cancer inequities should inform testing of ambitious and innovative interventions as we work toward equity in care and outcomes. PATIENT SUMMARY Men of African ancestry demonstrate the highest rates of prostate cancer mortality, which may be reduced through social interventions. We present a framework for formalizing the identification of the drivers of prostate cancer inequities to facilitate the development of interventions and trials to eradicate them.
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Affiliation(s)
- Yaw A Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Matthew R Cooperberg
- Department of Urology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christopher Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA, USA
| | - Franklin Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl T Lee
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Mark S Litwin
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes, Institute of Epidemiology & Health Care, University College London, London, UK
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Curtis Pettaway
- Department of Urology, M.D. Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Isaac J Powell
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Peter Sasieni
- Cancer Research UK & King's College London Cancer Prevention Trials Unit, King's College London, London, UK
| | - Edward M Schaeffer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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7
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Steck SE, Su LJ, Antwi SO, Morris BB, Crawford B, Adams SA, Hebert JR, Fontham ETH, Bensen JT, Mohler JL, Arab L. Recreational and occupational physical activity in relation to prostate cancer aggressiveness: the North Carolina-Louisiana Prostate Cancer Project (PCaP). Cancer Causes Control 2022; 33:875-887. [PMID: 35320830 PMCID: PMC10964168 DOI: 10.1007/s10552-022-01572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine associations between recreational and occupational physical activity and prostate cancer aggressiveness in a population-based, case-only, incident prostate cancer study. METHODS Data were analyzed from the cross-sectional North Carolina-Louisiana Prostate Cancer Project of African-American (n = 1,023) and European-American (n = 1,079) men newly diagnosed with prostate cancer (CaP). High-aggressive CaP was defined as Gleason sum ≥ 8, or prostate-specific antigen > 20 ng/ml, or Gleason sum ≥ 7 and clinical stage T3-T4. Metabolic equivalent tasks (MET) were estimated from self-reported recreational physical activity in the year prior to diagnosis assessed retrospectively via a validated questionnaire and from occupational physical activity based on job titles. Associations between physical activity variables and high-aggressive prostate cancer were estimated using logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for multiple confounders. RESULTS There was suggestive evidence that walking for 75-150 min/week for exercise is associated with lower odds of high-aggressive prostate cancer compared to no walking (OR = 0.69, 95% CI 0.47-1.01). Physical activity at the current job was associated with 24% lower odds of high-aggressive prostate cancer (highest vs. lowest tertile OR = 0.76, 95% CI 0.56-1.04). However, total MET-h/week of recreational physical activity and accumulation of high-level physical activity at the longest-held job were not associated with high-aggressive prostate cancer. Results did not vary by race. CONCLUSIONS The odds of high-aggressive prostate cancer were lower among men who walk for exercise and those engaged in occupations with high activity levels.
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Affiliation(s)
- Susan E Steck
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 456, Columbia, SC, 29208, USA.
| | - L Joseph Su
- Department of Epidemiology, Fay W. Boozman College of Public Health, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Samuel O Antwi
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Bonny B Morris
- Wake Forest Baptist Medical Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Brittany Crawford
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Swann Arp Adams
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - James R Hebert
- Epidemiology and Biostatistics, and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Elizabeth T H Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lenore Arab
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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8
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K. C. M, Oral E, Rung AL, Trapido EJ, Rozek LS, Fontham ETH, Bensen JT, Farnan L, Steck SE, Song L, Mohler JL, Peters ES. Neighborhood deprivation and risk of mortality among men with prostate cancer: Findings from a long-term follow-up study. Prostate 2022; 82:783-792. [PMID: 35201637 PMCID: PMC9306458 DOI: 10.1002/pros.24320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The overall survival rate of prostate cancer (PCa) has improved over the past decades. However, huge socioeconomic and racial disparities in overall and prostate cancer-specific mortality exist. The neighborhood-level factors including socioeconomic disadvantage and lack of access to care may contribute to disparities in cancer mortality. This study examines the impact of neighborhood deprivation on mortality among PCa survivors. METHODS North Carolina-Louisiana Prostate Cancer Project (PCaP) data were used. A total of 2113 men, 1046 AA and 1067 EA, with PCa were included in the analysis. Neighborhood deprivation was measured by the Area Deprivation Index (ADI) at the census block group level using data from the US Census Bureau. Quintiles of ADI were created. Cox proportional hazards and competing risk models with mixed effects were performed to estimate the effect of neighborhood deprivation on all-cause and PCa-specific mortality adjusted for age, race, study site, insurance status, and comorbidities. RESULTS Participants living in the most deprived neighborhoods had an increased risk for all-cause mortality (quintiles 4 + 5: adjusted hazard ratio [aHR] = 1.51, 95% confidence interval [CI] = 1.16-1.96) compared to those in the least deprived (quintile 1) neighborhoods. The risk of prostate cancer-specific mortality was also higher among those living in the deprived neighborhoods (quintiles 4 + 5: aHR = 1.90, 95% CI = 1.10-3.50) than those in the least deprived neighborhood. CONCLUSIONS The findings suggest neighborhood-level resources or health interventions are essential to improve survival among men with PCa. Additional research should focus on the mechanisms of how the neighborhood environment affects mortality.
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Affiliation(s)
- Madhav K. C.
- Department of Internal Medicine, Yale School of MedicineCancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterNew HavenConnecticutUSA
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Evrim Oral
- Department of Biostatistics, School of Public HealthBiostatistics Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Ariane L. Rung
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Edward J. Trapido
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Laura S. Rozek
- Department of Environmental Health SciencesUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Elizabeth T. H. Fontham
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
| | - Jeannette T. Bensen
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer Center, School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Susan E. Steck
- Department of Epidemiology and BiostatisticsArnold School of Public Health, University of South CarolinaColumbiaSouth CarolinaUSA
| | - Lixin Song
- School of NursingUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - James L. Mohler
- Department of UrologyRoswell Park Comprehensive Cancer CenterNew YorkNew YorkUSA
| | - Edward S. Peters
- Department of Epidemiology, School of public HealthEpidemiology Program, Louisiana State University Health Sciences Center‐New OrleansNew OrleansLouisianaUSA
- Department of EpidemiologyCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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9
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Tang L, Zhu Q, Wang Z, Shanahan CM, Bensen JT, Fontham ETH, Smith GJ, Pop EA, Azabdaftari G, Mohler JL, Wu Y. Differential Associations of SLCO Transporters with Prostate Cancer Aggressiveness between African Americans and European Americans. Cancer Epidemiol Biomarkers Prev 2021; 30:990-999. [PMID: 33619025 DOI: 10.1158/1055-9965.epi-20-1389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 02/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Androgen receptor signaling is crucial to prostate cancer aggressiveness. Members of the solute carrier family of the organic anion transporting peptides (SLCO) are potential regulators of androgen availability in prostate tissue. It remains unknown whether genetic variations in SLCOs contribute to the differences in prostate cancer aggressiveness in African Americans (AA) and European Americans (EA). METHODS SNPs in 11 SLCO members were selected, with addition of 139 potentially functional SNPs and 128 ancestry informative markers. A total of 1,045 SNPs were genotyped and analyzed in 993 AAs and 1,057 EAs from the North Carolina-Louisiana Prostate Cancer Project. Expression and cellular localization of SLCOs were examined using qRT-PCR, IHC, and in situ RNA hybridization in independent sets of prostate cancer cases. RESULTS Significant associations with prostate cancer characteristics were found for SNPs in SLCO2A1 and SLCO5A1. The associations differed by race (P interaction < 0.05). SNPs in SLCO2A1 were associated with reduced tumor aggressiveness and low Gleason score in AAs; whereas, SNPs in SLCO5A1 were associated with high clinical stage in EAs. In prostate tissue, SLCO2A1 and SLCO5A1 were the most expressed SLCOs at the mRNA level and were expressed predominantly in prostate endothelial and epithelial cells at the protein level, respectively. CONCLUSIONS SLCO2A1 and SLCO5A1 play important but different roles in prostate cancer aggressiveness in AAs versus EAs. IMPACT The finding calls for consideration of racial differences in biomarker studies of prostate cancer and for investigations on functions of SLCO2A1 and SLCO5A1 in prostate cancer.
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Affiliation(s)
- Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
| | - Qianqian Zhu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Zinian Wang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Clayton M Shanahan
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jeannette T Bensen
- Department of Epidemiology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Gary J Smith
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elena A Pop
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Gissou Azabdaftari
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Yue Wu
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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10
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Understanding the Relationship between Environmental Arsenic and Prostate Cancer Aggressiveness among African-American and European-American Men in North Carolina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228364. [PMID: 33198142 PMCID: PMC7697081 DOI: 10.3390/ijerph17228364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023]
Abstract
High-level exposure to arsenic, a known carcinogen and endocrine disruptor, is associated with prostate cancer (PCa) mortality. Whether low-level exposure is associated with PCa aggressiveness remains unknown. We examined the association between urinary arsenic and PCa aggressiveness among men in North Carolina. This cross-sectional study included 463 African-American and 491 European-American men with newly diagnosed, histologically confirmed prostate adenocarcinoma. PCa aggressiveness was defined as low aggressive (Gleason score < 7, stage = cT1–cT2, and PSA < 10 ng/mL) versus intermediate/high aggressive (all other cases). Total arsenic and arsenical species (inorganic arsenic (iAsIII + iAsV), arsenobetaine, monomethyl arsenic, and dimethyl arsenic)) and specific gravity were measured in spot urine samples obtained an average of 23.7 weeks after diagnosis. Multivariable logistic regression was used to estimate the covariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for PCa aggressiveness in association with arsenic tertiles/quantiles overall and by race. The highest (vs. lowest) tertile of total arsenic was associated with PCa aggressiveness ORs of 1.77 (95% CI = 1.05–2.98) among European-American men, and 0.94 (95% CI = 0.57–1.56) among African-American men (PInteraction = 0.04). In contrast, total arsenic and arsenical species were not associated with PCa aggressiveness in unstratified models. Low-level arsenic exposure may be associated with PCa aggressiveness among European-Americans, but not among African-Americans.
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11
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Snider AJ, Seeds MC, Johnstone L, Snider JM, Hallmark B, Dutta R, Moraga Franco C, Parks JS, Bensen JT, Broeckling CD, Mohler JL, Smith GJ, Fontham ET, Lin HK, Bresette W, Sergeant S, Chilton FH. Identification of Plasma Glycosphingolipids as Potential Biomarkers for Prostate Cancer (PCa) Status. Biomolecules 2020; 10:E1393. [PMID: 33007922 PMCID: PMC7600119 DOI: 10.3390/biom10101393] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023] Open
Abstract
Prostate cancer (PCa) is the most common male cancer and the second leading cause of cancer death in United States men. Controversy continues over the effectiveness of prostate-specific antigen (PSA) for distinguishing aggressive from indolent PCa. There is a critical need for more specific and sensitive biomarkers to detect and distinguish low- versus high-risk PCa cases. Discovery metabolomics were performed utilizing ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS) on plasma samples from 159 men with treatment naïve prostate cancer participating in the North Carolina-Louisiana PCa Project to determine if there were metabolites associated with aggressive PCa. Thirty-five identifiable plasma small molecules were associated with PCa aggressiveness, 15 of which were sphingolipids; nine common molecules were present in both African-American and European-American men. The molecules most associated with PCa aggressiveness were glycosphingolipids; levels of trihexosylceramide and tetrahexosylceramide were most closely associated with high-aggressive PCa. The Cancer Genome Atlas was queried to determine gene alterations within glycosphingolipid metabolism that are associated with PCa and other cancers. Genes that encode enzymes associated with the metabolism of glycosphingolipids were altered in 12% of PCa and >30% of lung, uterine, and ovarian cancers. These data suggest that the identified plasma (glyco)sphingolipids should be further validated for their association with aggressive PCa, suggesting that specific sphingolipids may be included in a diagnostic signature for PCa.
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Affiliation(s)
- Ashley J. Snider
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA; (A.J.S.); (L.J.); (J.M.S.); (B.H.); (C.M.F.); (W.B.)
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Michael C. Seeds
- Wake Forest Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Laurel Johnstone
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA; (A.J.S.); (L.J.); (J.M.S.); (B.H.); (C.M.F.); (W.B.)
| | - Justin M. Snider
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA; (A.J.S.); (L.J.); (J.M.S.); (B.H.); (C.M.F.); (W.B.)
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY 11794, USA
| | - Brian Hallmark
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA; (A.J.S.); (L.J.); (J.M.S.); (B.H.); (C.M.F.); (W.B.)
| | - Rahul Dutta
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC 27103, USA;
| | - Cristina Moraga Franco
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA; (A.J.S.); (L.J.); (J.M.S.); (B.H.); (C.M.F.); (W.B.)
| | - John S. Parks
- Department of Internal Medicine-Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Jeannette T. Bensen
- North Carolina and Louisiana Prostate Cancer Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Corey D. Broeckling
- Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, CO 80523, USA;
| | - James L. Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (J.L.M.); (G.J.S.)
| | - Gary J. Smith
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (J.L.M.); (G.J.S.)
| | - Elizabeth T.H. Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA;
| | - Hui-Kuan Lin
- Cancer Biology Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC 27101, USA;
| | - William Bresette
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA; (A.J.S.); (L.J.); (J.M.S.); (B.H.); (C.M.F.); (W.B.)
| | - Susan Sergeant
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Floyd H. Chilton
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ 85721, USA; (A.J.S.); (L.J.); (J.M.S.); (B.H.); (C.M.F.); (W.B.)
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
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12
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Ramakrishnan S, Steck SE, Arab L, Zhang H, Bensen JT, Fontham ETH, Johnson CS, Mohler JL, Smith GJ, Su LJ, Woloszynska A. Association among plasma 1,25(OH) 2 D, ratio of 1,25(OH) 2 D to 25(OH)D, and prostate cancer aggressiveness. Prostate 2019; 79:1117-1124. [PMID: 31077420 PMCID: PMC6593756 DOI: 10.1002/pros.23824] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/20/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND African-American (AA) men tend to present with more aggressive prostate cancer (Gleason score >7) than European-American (EA) men. Vitamin D and its metabolites are implicated in prostate cancer biology with vitamin D deficiency, indicated by its metabolite levels in serum or plasma, usually observed in AA men. OBJECTIVE To determine if 1, 25-dihydroxy vitamin D3 [1,25(OH)2 D] plasma levels in AA and EA prostate cancer patients alter the risk of having aggressive prostate cancer. DESIGN Research subjects from the North Carolina-Louisiana Prostate Cancer Project (AA n = 435 and EA n = 532) were included. Plasma metabolites 1,25(OH)2 D and 25-hydroxyvitamin D3 [25(OH)D] were measured using liquid chromatography with tandem mass spectrophotometry. Research subjects were classified into low (Gleason sum < 7, stage T1-T2, and Prostate-specific antigen (PSA) < 9 ng/mL) or high (Gleason sum > 8 or Gleason sum = 7 with 4 + 3, or PSA > 20 ng/mL, or Gleason sum = 7 and stage T3-T4) aggressive disease. RESULTS Research subjects in the second and third tertiles of plasma levels of 1, 25(OH)2 D had lower odds of high aggressive prostate cancer (AA [ORT2vsT1 : 0.66, 95%CI: 0.39-1.12; ORT3vsT1 : 0.83, 95%CI: 0.49-1.41] and EA [ORT2vsT1 : 0.68, 95%CI: 0.41-1.11; ORT3vsT1 : 0.67, 95%CI: 0.40-1.11]) compared with the first tertile, though confidence intervals included the null. Greater 1,25(OH)2 D/25(OH)D molar ratios were associated with lower odds of high aggressive prostate cancer more evidently in AA (ORQ4vsQ1 : 0.45, CI: 0.24-0.82) than in EA (ORQ4vsQ1 : 0.64, CI: 0.35-1.17) research subjects. CONCLUSIONS The 1,25(OH)2 D/25(OH)D molar ratio was associated with decreased risk of high aggressive prostate cancer in AA men, and possibly in EA men. Further studies analyzing vitamin D polymorphisms, vitamin D binding protein levels, and prostatic levels of these metabolites may be useful. These studies may provide a better understanding of the vitamin D pathway and its biological role underlying health disparities in prostate cancer.
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Affiliation(s)
- Swathi Ramakrishnan
- Department of Pharmacology and TherapeuticsRoswell Park Comprehensive Cancer CenterBuffaloNew York
| | - Susan E. Steck
- Department of Epidemiology and BiostatisticsArnold School of Public Health, University of South CarolinaColumbiaSouth Carolina
| | - Lenore Arab
- David Geffen School of MedicineUniversity of CaliforniaLos AngelesCalifornia
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental HealthUniversity of MemphisMemphisTennessee
| | - Jeannette T. Bensen
- Department of EpidemiologyGillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Elizabeth T. H. Fontham
- School of Public HealthLouisiana State University Health Sciences CenterNew OrleansLouisiana
| | - Candace S. Johnson
- Department of Pharmacology and TherapeuticsRoswell Park Comprehensive Cancer CenterBuffaloNew York
| | - James L. Mohler
- Department of UrologyRoswell Park Comprehensive Cancer CenterBuffaloNew York
| | - Gary J. Smith
- Department of UrologyRoswell Park Comprehensive Cancer CenterBuffaloNew York
| | - L. Joseph Su
- Winthrop P. Rockefeller Cancer Institute, Department of Epidemiology, Fay W. Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockArkansas
| | - Anna Woloszynska
- Department of Pharmacology and TherapeuticsRoswell Park Comprehensive Cancer CenterBuffaloNew York
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13
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Erim DO, Bensen JT, Mohler JL, Fontham ETH, Song L, Farnan L, Delacroix SE, Peters ES, Erim TN, Chen RC, Gaynes BN. Prevalence and predictors of probable depression in prostate cancer survivors. Cancer 2019; 125:3418-3427. [PMID: 31246284 DOI: 10.1002/cncr.32338] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The early diagnosis and treatment of depression are cancer care priorities. These priorities are critical for prostate cancer survivors because men rarely seek mental health care. However, little is known about the epidemiology of depression in this patient population. The goal of this study was to describe the prevalence and predictors of probable depression in prostate cancer survivors. METHODS The data were from a population-based cohort of North Carolinian prostate cancer survivors who were enrolled from 2004 to 2007 in the North Carolina-Louisiana Prostate Cancer Project (n = 1031) and were prospectively followed annually from 2008 to 2011 in the Health Care Access and Prostate Cancer Treatment in North Carolina study (n = 805). Generalized estimating equations were used to evaluate an indicator of probable depression (Short Form 12 mental composite score ≤48.9; measured at enrollment and during the annual follow-up) as a function of individual-level characteristics within the longitudinal data set. RESULTS The prevalence of probable depression fell from 38% in the year of the cancer diagnosis to 20% 6 to 7 years later. Risk factors for probable depression throughout the study were African American race, unemployment, low annual income, younger age, recency of cancer diagnosis, past depression, comorbidities, treatment decisional regret, and nonadherence to exercise recommendations. CONCLUSIONS Depression is a major challenge for prostate cancer survivors, particularly in the first 5 years after the cancer diagnosis. To the authors' knowledge, this is the first study to demonstrate an association between treatment decisional regret and probable depression.
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Affiliation(s)
- Daniel O Erim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,RTI International, Research Triangle Park, North Carolina
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elizabeth T H Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Scott E Delacroix
- Department of Urology, Louisiana State University, New Orleans, Louisiana
| | - Edward S Peters
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - Ronald C Chen
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
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14
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Erim DO, Bensen JT, Mohler JL, Fontham ETH, Song L, Farnan L, Delacroix SE, Peters ES, Erim TN, Chen RC, Gaynes BN. Patterns and predictors of self-reported clinical diagnosis and treatment for depression in prostate cancer survivors. Cancer Med 2019; 8:3648-3658. [PMID: 31106980 PMCID: PMC6639178 DOI: 10.1002/cam4.2239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 12/18/2022] Open
Abstract
Background Appropriate depression care is a cancer‐care priority. However, many cancer survivors live with undiagnosed and untreated depression. Prostate cancer survivors may be particularly vulnerable, but little is known about their access to depression care. The goal of this study was to describe patterns and predictors of clinical diagnosis and treatment of depression in prostate cancer survivors. Methods Generalized estimating equations were used to evaluate indicators of self‐reported clinical diagnosis and treatment depression as a function of individual‐level characteristics within a longitudinal dataset. The data were from a population‐based cohort of North Carolinian prostate cancer survivors who were enrolled from 2004 to 2007 on the North Carolina‐Louisiana Prostate Cancer Project (N = 1,031), and prospectively followed annually from 2008 to 2011 on the Health Care Access and Prostate Cancer Treatment in North Carolina (N = 805). Results The average rate of self‐reported clinical diagnosis of depression was 44% (95% CI: 39%‐49%), which declined from 60% to 40% between prostate cancer diagnosis and 5‐7 years later. Factors associated with lower odds of self‐reported clinical diagnosis of depression include African‐American race, employment, age at enrollment, low education, infrequent primary care visits, and living with a prostate cancer diagnosis for more than 2 years. The average rate of self‐reported depression treatment was 62% (95% CI: 55%‐69%). Factors associated with lower odds of self‐reported depression treatment included employment and living with a prostate cancer diagnosis for 2 or more years. Conclusion Prostate cancer survivors experience barriers when in need of depression care.
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Affiliation(s)
- Daniel O Erim
- Department of Health Policy and Management, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,RTI International, Research Triangle Park, North Carolina
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Elizabeth T H Fontham
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Scott E Delacroix
- Department of Urology, Louisiana State University, New Orleans, Louisiana
| | - Edward S Peters
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | | | - Ronald C Chen
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina.,Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
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15
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The association of metformin use with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study. Cancer Causes Control 2018; 29:1143-1150. [PMID: 30267174 DOI: 10.1007/s10552-018-1087-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/25/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Metformin has been associated with a reduced incidence of prostate cancer and improved prostate cancer outcomes. However, whether race modifies the association between metformin use and prostate cancer aggressiveness remains uncertain. The association between metformin use and prostate cancer aggressiveness was examined separately in Black Americans (Blacks) and White Americans (Whites). METHODS The study population consisted of 305 Black and 195 White research participants with incident prostate cancer and self-reported diabetes from the North Carolina-Louisiana Prostate Cancer Project. High-aggressive prostate cancer was defined using a composite measure of Gleason sum, prostate-specific antigen, and clinical stage. Multivariable logistic regression was used to assess the association between metformin use and high-aggressive prostate cancer at diagnosis, separately among Whites and Blacks, with adjustment for age, screening history, site, education, insurance, and body mass index. RESULTS Metformin use was associated positively with high-aggressive prostate cancer in Blacks (OR 2.01; 95% CI 1.05, 3.83). By contrast, a weak inverse association between metformin use and high-aggressive prostate cancer was found in Whites (OR 0.80, 95% CI 0.34, 1.85). CONCLUSIONS The association between metformin use and prostate cancer aggressiveness may be modified by race.
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16
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Schneider L, Su LJ, Arab L, Bensen JT, Farnan L, Fontham ETH, Song L, Hussey J, Merchant AT, Mohler JL, Steck SE. Dietary patterns based on the Mediterranean diet and DASH diet are inversely associated with high aggressive prostate cancer in PCaP. Ann Epidemiol 2018; 29:16-22.e1. [PMID: 30268488 DOI: 10.1016/j.annepidem.2018.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/12/2018] [Accepted: 08/30/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several foods and nutrients have been linked to the development of prostate cancer, but the association between healthy dietary patterns and prostate cancer aggressiveness is less studied. The aim of this study was to evaluate the relationship between the Mediterranean diet (MED) and Dietary Approaches to Stop Hypertension (DASH) diet scores and prostate cancer aggressiveness by race. METHODS Data from the population-based, case-only North Carolina-Louisiana Prostate Cancer Project (PCaP) were used to examine the association between diet quality, measured by MED and DASH scores, and prostate cancer aggressiveness in 1899 African American (AA) and European American (EA) research subjects. Dietary intake was assessed using a modified National Cancer Institute Diet History Questionnaire. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for high versus low-intermediate aggressive prostate cancer. RESULTS Higher MED scores were inversely associated with high aggressive prostate cancer overall (OR: 0.66; 95% CI: 0.46, 0.95 for high versus low scores); results were similar for AA and EA men. A weaker inverse association between DASH scores and prostate cancer aggressiveness was found (OR: 0.76; 95% CI: 0.55, 1.06). CONCLUSIONS Higher diet quality, as represented by a Mediterranean-style diet or DASH diet, may reduce the odds of high aggressive prostate cancer.
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Affiliation(s)
- Lara Schneider
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - L Joseph Su
- Winthrop P Rockefeller Cancer Institute and College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Lenore Arab
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jeannette T Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth T H Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James Hussey
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - James L Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.
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Allott EH, Farnan L, Steck SE, Song L, Arab L, Su LJ, Fontham ETH, Mohler JL, Bensen JT. Statin use, high cholesterol and prostate cancer progression; results from HCaP-NC. Prostate 2018; 78:857-864. [PMID: 29717502 DOI: 10.1002/pros.23644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/06/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Statin use is associated with lower advanced prostate cancer risk and reduced prostate cancer-specific mortality, but prior studies were conducted mainly in white men. We examined the effect of statin use on risk of prostate cancer progression in a population-based, minority-enriched cohort. METHODS We used data from prostate cancer cases (45% African American) diagnosed between 2004 and 2007 who participated in the Health Care Access and Prostate Cancer Treatment in North Carolina cohort (HCaP-NC). We abstracted statin use at diagnosis. Men reported if they had ever been diagnosed with high cholesterol. Multivariable Cox proportional hazards analysis was used to examine associations between statin use and risk of prostate cancer progression (biochemical recurrence or secondary treatment), overall and by race. In secondary analysis, we examined the association between high cholesterol and risk of progression, overall, and by statin use. RESULTS Of 669 men, 244 (36%) were statin users at diagnosis. During 3.8 years median follow-up, 138 men experienced prostate cancer progression. There was no association between statin use and risk of progression, either overall (HR 1.03; 95%CI 0.72-1.46) or stratified by race. High cholesterol was inversely associated with risk of progression, particularly among statin users (HR 0.43; 95%CI 0.20-0.94; p-interaction = 0.22) and in men with higher perceived access to care (HR 0.57; 95%CI 0.36-0.90; p-interaction = 0.03). Study limitations included a relatively small sample size, short follow-up, and lack of data regarding post diagnosis statin use. CONCLUSIONS Statin use at diagnosis was not associated with prostate cancer progression in the population-based, minority-enriched HCaP-NC. Greater healthcare engagement, including actively controlling serum cholesterol, may be linked to better prostate cancer-specific outcomes.
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Affiliation(s)
- Emma H Allott
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susan E Steck
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Lixin Song
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lenore Arab
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - L Joseph Su
- Winthrop P Rockefeller Cancer Institute and College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Elizabeth T H Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - James L Mohler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeannette T Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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18
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Spiers S, Oral E, Fontham ETH, Peters ES, Mohler JL, Bensen JT, Brennan CS. Modelling attrition and nonparticipation in a longitudinal study of prostate cancer. BMC Med Res Methodol 2018; 18:60. [PMID: 29925318 PMCID: PMC6011525 DOI: 10.1186/s12874-018-0518-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/06/2018] [Indexed: 11/28/2022] Open
Abstract
Background Attrition occurs when a participant fails to respond to one or more study waves. The accumulation of attrition over several waves can lower the sample size and power and create a final sample that could differ in characteristics than those who drop out. The main reason to conduct a longitudinal study is to analyze repeated measures; research subjects who drop out cannot be replaced easily. Our group recently investigated factors affecting nonparticipation (refusal) in the first wave of a population-based study of prostate cancer. In this study we assess factors affecting attrition in the second wave of the same study. We compare factors affecting nonparticipation in the second wave to the ones affecting nonparticipation in the first wave. Methods Information available on participants in the first wave was used to model attrition. Different sources of attrition were investigated separately. The overall and race-stratified factors affecting attrition were assessed. Kaplan-Meier survival curve estimates were calculated to assess the impact of follow-up time on participation. Results High cancer aggressiveness was the main predictor of attrition due to death or frailty. Higher Charlson Comorbidity Index increased the odds of attrition due to death or frailty only in African Americans (AAs). Young age at diagnosis for AAs and low income for European Americans (EAs) were predictors for attrition due to lost to follow-up. High cancer aggressiveness for AAs, low income for EAs, and lower patient provider communication scores for EAs were predictors for attrition due to refusal. These predictors of nonparticipation were not the same as those in wave 1. For short follow-up time, the participation probability of EAs was higher than that of AAs. Conclusions Predictors of attrition can vary depending on the attrition source. Examining overall attrition (combining all sources of attrition under one category) instead of distinguishing among its different sources should be avoided. The factors affecting attrition in one wave can be different in a later wave and should be studied separately.
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Affiliation(s)
- Samantha Spiers
- LSUHSC, School of Public Health, Biostatistics Program, New Orleans, USA
| | - Evrim Oral
- LSUHSC, School of Public Health, Biostatistics Program, New Orleans, USA.
| | | | - Edward S Peters
- LSUHSC, School of Public Health, Epidemiology Program, New Orleans, USA
| | - James L Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, USA.,Lineberger Comprehensive Cancer Center, UNC-Chapel Hill, Chapel Hill, USA
| | - Jeannette T Bensen
- Lineberger Comprehensive Cancer Center, UNC-Chapel Hill, Chapel Hill, USA
| | - Christine S Brennan
- LSUHSC, School of Public Health, Health Policy and Systems Management Program, New Orleans, USA
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19
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Steck SE, Omofuma OO, Su LJ, Maise AA, Woloszynska-Read A, Johnson CS, Zhang H, Bensen JT, Fontham ETH, Mohler JL, Arab L. Calcium, magnesium, and whole-milk intakes and high-aggressive prostate cancer in the North Carolina–Louisiana Prostate Cancer Project (PCaP). Am J Clin Nutr 2018; 107:799-807. [DOI: 10.1093/ajcn/nqy037] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/07/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Susan E Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Omonefe O Omofuma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - L Joseph Su
- Winthrop P Rockefeller Cancer Institute, Department of Epidemiology, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Amanda A Maise
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Community Care Behavioral Health, University of Pittsburgh Medical Center Insurance Services Division, Pittsburgh, PA
| | | | | | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Jeannette T Bensen
- Department of Epidemiology, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth T H Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
| | | | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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20
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Smitherman AB, Anderson C, Lund JL, Bensen JT, Rosenstein DL, Nichols HB. Frailty and Comorbidities Among Survivors of Adolescent and Young Adult Cancer: A Cross-Sectional Examination of a Hospital-Based Survivorship Cohort. J Adolesc Young Adult Oncol 2018; 7:374-383. [PMID: 29570988 DOI: 10.1089/jayao.2017.0103] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Cancer survivors are at increased risk for the early development of age-related chronic medical conditions compared with peers without a history of cancer; however, little is known regarding the burden of these conditions among survivors of adolescent and young adult (AYA) cancers. In response, we sought to determine the prevalence of specific comorbidities and frailty among AYAs (15-39 years old at diagnosis) enrolled in a cancer survivorship cohort. METHODS Using a cross-sectional survey of a tertiary medical center-based cancer survivorship cohort, we determined the prevalence of specific comorbidities and frailty using the survey-based FRAIL assessment. In separate models adjusting for age, we estimated prevalence ratios (PRs) for the associations between patient characteristics and (1) any comorbidity and (2) frailty or prefrailty using log-binomial models. RESULTS We identified 271 AYA cancer survivors, most of whom were 30-39 years old at survey (57%). A majority of survivors (n = 163, 60%) reported having at least one comorbidity with the most common being depression (28%), anxiety (27%), asthma (17%), high cholesterol (15%), and hypertension (15%). Of the 184 AYA survivors at least 1 year from cancer diagnosis, 19 (10%) were classified as frail and 39 (21%) as prefrail. Survivors who were smokers (PR 2.0, 95% confidence interval [CI]: 1.16-3.56); obese (PR 1.7, 95% CI: 1.10-2.55); uninsured (PR 2.7, 95% CI: 1.63-4.59); or who reported comorbid depression or anxiety (PR 2.4, 95% CI: 1.51-3.67) were more likely to be frail or prefrail. CONCLUSIONS The prevalence of frailty and comorbidities is high among AYA cancer survivors suggestive of accelerated aging.
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Affiliation(s)
- Andrew B Smitherman
- 1 The Division of Pediatric Hematology/Oncology, University of North Carolina , Chapel Hill, North Carolina.,2 The Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill, North Carolina
| | - Chelsea Anderson
- 3 The Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina
| | - Jennifer L Lund
- 2 The Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill, North Carolina.,3 The Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina
| | - Jeannette T Bensen
- 2 The Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill, North Carolina.,3 The Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina
| | - Donald L Rosenstein
- 2 The Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill, North Carolina.,4 The Department of Psychiatry, University of North Carolina , Chapel Hill, North Carolina
| | - Hazel B Nichols
- 2 The Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill, North Carolina.,3 The Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina
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21
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eHealth Literacy and Partner Involvement in Treatment Decision Making for Men With Newly Diagnosed Localized Prostate Cancer. Oncol Nurs Forum 2018; 44:225-233. [PMID: 28222090 DOI: 10.1011/17.onf.225-233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE/OBJECTIVES To examine how the eHealth literacy of partners of patients with newly diagnosed prostate cancer affects their involvement in decision making, and to identify the factors that influence their eHealth literacy.
. DESIGN Cross-sectional exploratory study.
. SETTING North Carolina.
. SAMPLE 142 partners of men with newly diagnosed localized prostate cancer.
. METHODS A telephone survey and descriptive and multiple linear regression analyses were used.
. MAIN RESEARCH VARIABLES The partners' eHealth literacy, involvement in treatment decision making, and demographics, and the health statuses of the patients and their partners.
. FINDINGS Higher levels of eHealth literacy among partners were significantly associated with their involvement in getting a second opinion, their awareness of treatment options, and the size of the social network they relied on for additional information and support for treatment decision making for prostate cancer. The factor influencing eHealth literacy was the partners' access to the Internet for personal use, which explained some of the variance in eHealth literacy.
. CONCLUSIONS This study described how partners' eHealth literacy influenced their involvement in treatment decision making for prostate cancer and highlighted the influencing factors (i.e., partners' access to the Internet for personal use).
. IMPLICATIONS FOR NURSING When helping men with prostate cancer and their partners with treatment decision making, nurses need to assess eHealth literacy levels to determine whether nonelectronically based education materials are needed and to provide clear instructions on how to use eHealth resources.
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22
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Khan S, Cai J, Nielsen ME, Troester MA, Mohler JL, Fontham ETH, Hendrix LH, Farnan L, Olshan AF, Bensen JT. The Association of Diabetes and Obesity With Prostate Cancer Progression: HCaP-NC. Prostate 2017; 77:878-887. [PMID: 28261834 PMCID: PMC5695861 DOI: 10.1002/pros.23342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/13/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of race in modifying the association among diabetes, obesity, and prostate cancer (CaP) progression is not well studied. We evaluated diabetes and obesity in association with time to CaP progression in White Americans (Whites) and Black Americans (Blacks). METHODS Our study sample consisted of 363 White and 284 Black research participants from the Health Care Access and CaP Treatment in North Carolina (HCaP-NC) cohort. The association between self-reported diabetes or obesity and CaP progression (mean follow-up time approximately 5 years) was assessed using Cox proportional hazards modeling, with adjustment for potential confounders. Stratum-specific hazard ratio (HR) estimates for Whites and Blacks were evaluated. RESULTS Self-reported diabetes was not associated with CaP progression in the cohort as a whole (HR: 0.86, 95%CI: 0.54, 1.35), or among racially defined groups (Whites, HR: 1.03, 95%CI: 0.50, 2.13 or Blacks, HR: 0.77, 95%CI: 0.43, 1.39). Obesity was positively associated with CaP progression among Whites, in models including (HR: 1.79, 95%CI: 1.08, 2.97), and excluding (HR: 1.80, 95%CI: 1.09, 2.96) diabetes as a covariate. No association was observed between obesity and CaP progression in Blacks or the cohort as whole. CONCLUSIONS Self-reported diabetes was not associated with CaP progression In HCaP-NC. Obesity was associated with CaP progression only among White research participants. Prostate 77:878-887, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E. Nielsen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Department of Urology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Melissa A. Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - James L. Mohler
- Department of Urology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
- Department of Urology, University of Buffalo School of Medicine and Biotechnology, Buffalo, New York
| | - Elizabeth T. H. Fontham
- School of Public Health, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Laura H. Hendrix
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jeannette T. Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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23
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Oral E, Simonsen N, Brennan C, Berken J, Su LJ, Mohler JL, Bensen JT, Fontham ETH. Unit Nonresponse in a Population-Based Study of Prostate Cancer. PLoS One 2016; 11:e0168364. [PMID: 27992587 PMCID: PMC5161356 DOI: 10.1371/journal.pone.0168364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
Low unit response rates can increase bias and compromise study validity. Response rates have continued to fall over the past decade despite all efforts to increase participation. Many factors have been linked to reduced response, yet relatively few studies have employed multivariate approaches to identify characteristics that differentiate respondents from nonrespondents since it is hard to collect information on the latter. We aimed to assess factors contributing to enrollment of prostate cancer (PCa) patients. We combined data from the North Carolina-Louisiana (LA) PCa Project's LA cohort, with additional sources such as US census tract and LA tumor registry data. We included specific analyses focusing on blacks, a group often identified as hard to enroll in health-related research. The ability to study the effect of Hurricane Katrina, which occurred amidst enrollment, as a potential determinant of nonresponse makes our study unique. Older age (≥ 70) for blacks (OR 0.65) and study phase with respect to Hurricane Katrina for both races (OR 0.59 for blacks, OR 0.48 for whites) were significant predictors of participation with lower odds. Neighborhood poverty for whites (OR 1.53) also was a significant predictor of participation, but with higher odds. Among blacks, residence in Orleans parish was associated with lower odds of participation (OR 0.33) before Katrina. The opposite occurred in whites, with lower odds (OR 0.43) after Katrina. Our results overall underscore the importance of tailoring enrollment approaches to specific target population characteristics to confront the challenges posed by nonresponse. Our results also show that recruitment-related factors may change when outside forces bring major alterations to a population's environment and demographics.
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Affiliation(s)
- Evrim Oral
- Biostatistics Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Neal Simonsen
- Consultant Epidemiologist, New Orleans, Louisiana, United States of America
| | - Christine Brennan
- Health Policy and Systems Management Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
| | - Jennifer Berken
- Department of Mathematical Sciences, McNeese State University, Lake Charles, Louisiana, United States of America
| | - L. Joseph Su
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - James L. Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jeannette T. Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Elizabeth T. H. Fontham
- Epidemiology Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
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The association of diabetes and obesity with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study. Cancer Causes Control 2016; 27:1475-1485. [PMID: 27830399 DOI: 10.1007/s10552-016-0828-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Few studies have investigated the role of race in the association of diabetes and obesity with prostate cancer aggressiveness. Here we evaluate the independent association between diabetes and obesity with prostate cancer aggressiveness in White Americans and Black Americans. METHODS Our cross-sectional, case-only study consisted of 1,058 White Americans and 991 Black Americans from the North Carolina-Louisiana Prostate Cancer (PCaP) project. Diabetes status was determined by self-report. Obesity was determined using body mass index and calculated based on anthropometric measurements. High aggressive prostate cancer was defined as Gleason sum ≥8, or prostate-specific antigen >20 ng/ml, or Gleason sum = 7 and clinical stage cT3-cT4. The association between diabetes and obesity with high aggressive prostate cancer at diagnosis was evaluated using multivariable logistic regression and adjusted for potential confounders. RESULTS Diabetes was not associated with high aggressive prostate cancer in the overall sample (OR 1.04; 95% CI 0.79, 1.37), White Americans (OR 1.00; 95% CI 0.65, 1.57) or Black Americans (OR 1.07; 95% CI 0.75, 1.53). Obesity, independent of diabetes, was positively associated with high aggressive prostate cancer in White Americans (OR 1.98; 95% CI 1.14, 3.43), but not in the overall sample (OR 1.37; 95% CI 0.99, 1.92) or Black Americans (OR 1.09; 95% CI 0.71, 1.67). CONCLUSIONS Diabetes was not associated with prostate cancer aggressiveness, overall, or in either race group. Obesity, independent of diabetes, was associated with high aggressive prostate cancer only in White Americans.
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Holmes JA, Bensen JT, Mohler JL, Song L, Mishel MH, Chen RC. Quality of care received and patient-reported regret in prostate cancer: Analysis of a population-based prospective cohort. Cancer 2016; 123:138-143. [DOI: 10.1002/cncr.30315] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jordan A. Holmes
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jeannette T. Bensen
- Department of Epidemiology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
| | - James L. Mohler
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
- Department of Urology; Roswell Park Cancer Institute; Buffalo New York
| | - Lixin Song
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Merle H. Mishel
- School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ronald C. Chen
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- University of North Carolina-Lineberger Comprehensive Cancer Center; Chapel Hill North Carolina
- Sheps Center for Health Services Research; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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26
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Saturated fat intake and prostate cancer aggressiveness: results from the population-based North Carolina-Louisiana Prostate Cancer Project. Prostate Cancer Prostatic Dis 2016; 20:48-54. [DOI: 10.1038/pcan.2016.39] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/07/2016] [Accepted: 07/29/2016] [Indexed: 12/15/2022]
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27
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Antwi SO, Steck SE, Su LJ, Hebert JR, Zhang H, Craft NE, Fontham ETH, Smith GJ, Bensen JT, Mohler JL, Arab L. Carotenoid intake and adipose tissue carotenoid levels in relation to prostate cancer aggressiveness among African-American and European-American men in the North Carolina-Louisiana prostate cancer project (PCaP). Prostate 2016; 76:1053-66. [PMID: 27271547 PMCID: PMC5080909 DOI: 10.1002/pros.23189] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/29/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Associations between carotenoid intake and prostate cancer (CaP) incidence have varied across studies. This may result from combining indolent with aggressive disease in most studies. This study examined whether carotenoid intake and adipose tissue carotenoid levels were inversely associated with CaP aggressiveness. METHODS Data on African-American (AA, n = 1,023) and European-American (EA, n = 1,079) men with incident CaP from North Carolina and Louisiana were analyzed. Dietary carotenoid intake was assessed using a detailed-food frequency questionnaire (FFQ), and abdominal adipose tissue samples were analyzed for carotenoid concentrations using high-performance liquid chromatography. Multivariable logistic regression was used in race-stratified analyses to calculate odds ratios (ORs) and 95% confidence intervals (95%CI) comparing high aggressive CaP with low/intermediate aggressive CaP. RESULTS Carotenoid intake differed significantly between AAs and EAs, which included higher intake of lycopene among EAs and higher β-cryptoxanthin intake among AAs. Comparing the highest and lowest tertiles, dietary lycopene was associated inversely with high aggressive CaP among EAs (OR = 0.55, 95%CI: 0.34-0.89, Ptrend = 0.02), while an inverse association was observed between dietary β-cryptoxanthin intake and high aggressive CaP among AAs (OR = 0.56, 95%CI: 0.36-0.87, Ptrend = 0.01). Adipose tissue α-carotene and lycopene (cis + trans) concentrations were higher among EAs than AAs, and marginally significant inverse linear trends were observed for adipose α-carotene (Ptrend = 0.07) and lycopene (Ptrend = 0.11), and CaP aggressiveness among EAs only. CONCLUSIONS These results suggest that diets high in lycopene and β-cryptoxanthin may protect against aggressive CaP among EAs and AAs, respectively. Differences in dietary behaviors may explain the observed racial differences in associations. Prostate 76:1053-1066, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Samuel O. Antwi
- Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Susan E. Steck
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| | - L. Joseph Su
- Food and Drug Administration, Center for Devices and Radiological Health, Division of Epidemiology, University of Memphis, Memphis, TN
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | | | | | - Gary J. Smith
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Jeannette T. Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James L. Mohler
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Lenore Arab
- David Geffen School of Medicine at UCLA, Los Angeles, CA
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Vance TM, Wang Y, Su LJ, Fontham ETH, Steck SE, Arab L, Bensen JT, Mohler JL, Chen MH, Chun OK. Dietary Total Antioxidant Capacity is Inversely Associated with Prostate Cancer Aggressiveness in a Population-Based Study. Nutr Cancer 2016; 68:214-24. [PMID: 26847416 PMCID: PMC4821782 DOI: 10.1080/01635581.2016.1134596] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine the relationship between total antioxidant capacity (TAC) from diet and supplements and prostate cancer aggressiveness among 855 African Americans (AA) and 945 European Americans (EA) in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Cases were classified as either high aggressive, low aggressive, or intermediate aggressive. TAC was calculated from the vitamin C equivalent antioxidant capacity of 42 antioxidants measured via food frequency questionnaire. EA reported greater dietary TAC from diet and supplements combined (P < 0.0001). In both minimally and fully adjusted logistic regression models, TAC from diet and supplements combined was associated with a reduced odds of high aggressive prostate cancer in all men, AA and EA: odds ratios for highest vs. lowest level (>1500 vs. <500 mg vitamin C equivalent/day): 0.31 [95% confidence interval (CI): 0.15, 0.67; P-trend < 0.01], 0.28 (95% CI: 0.08, 0.96; P-trend < 0.001), and 0.36 (95% CI: 0.15, 0.86; P-trend = 0.58), respectively. These associations did not appear to differ between AA and EA. These data suggest that greater intake of antioxidants is associated with less aggressive prostate cancer. Additional research is needed to confirm these results and determine the underlying mechanisms.
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Affiliation(s)
- Terrence M. Vance
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
| | - Ying Wang
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
| | - L. Joseph Su
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | | - Susan E. Steck
- Department of Epidemiology and Biostatistics, Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| | - Lenore Arab
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Jeannette T. Bensen
- University of North Carolina at Chapel Hill, School of Public Health, Chapel Hill, NC
| | - James L. Mohler
- University of North Carolina at Chapel Hill, School of Public Health, Chapel Hill, NC
- Roswell Park Cancer Institute, Buffalo, NY
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT
| | - Ock K. Chun
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT
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29
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Allott EH, Farnan L, Steck SE, Arab L, Su LJ, Mishel M, Fontham ET, Mohler JL, Bensen JT. Statin Use and Prostate Cancer Aggressiveness: Results from the Population-Based North Carolina–Louisiana Prostate Cancer Project. Cancer Epidemiol Biomarkers Prev 2016; 25:670-7. [DOI: 10.1158/1055-9965.epi-15-0631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/24/2015] [Indexed: 11/16/2022] Open
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Intake of dietary antioxidants is inversely associated with biomarkers of oxidative stress among men with prostate cancer. Br J Nutr 2015; 115:68-74. [PMID: 26521663 DOI: 10.1017/s0007114515004249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prostate cancer is the most common non-cutaneous cancer and the second leading cause of cancer-related mortality among men in the USA. Growing evidence suggests that oxidative stress is involved in the development and progression of prostate cancer. In this study, the association between antioxidants from diet and supplements and biomarkers of oxidative stress in blood (n 278), urine (n 298) and prostate tissue (n 55) were determined among men from the North Carolina-Louisiana Prostate Cancer Project. The association between antioxidant intake and oxidative stress biomarkers in blood and urine was determined using linear regression, adjusting for age, race, prostate cancer aggressiveness and smoking status. Greater antioxidant intake was found to be associated with lower urinary 8-isoprostane concentrations, with a 10% increase in antioxidant intake corresponding to an unadjusted 1·1% decrease in urinary 8-isoprostane levels (95% CI -1·7, -0·3%; P value<0·01) and an adjusted 0·6% decrease (95% CI -1·4, 0·2%; P value=0·16). In benign prostate tissue, thioredoxin 1 was inversely associated with antioxidant intake (P=0·02). No significant associations were found for other blood or urinary biomarkers or for malignant prostate tissue. These results indicate that antioxidant intake may be associated with less oxidative stress among men diagnosed with prostate cancer.
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31
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Antwi S, Steck SE, Su LJ, Hebert JR, Zhang H, Fontham ETH, Smith G, Bensen JT, Mohler JL, Arab L. Dietary, supplement, and adipose tissue tocopherol levels in relation to prostate cancer aggressiveness among African and European Americans: The North Carolina-Louisiana Prostate Cancer Project (PCaP). Prostate 2015; 75:1419-35. [PMID: 26053590 PMCID: PMC5072779 DOI: 10.1002/pros.23025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/29/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Controversies remain over the safety and efficacy of vitamin E (i.e., α-tocopherol) supplementation use for the prevention of prostate cancer (CaP); however, associations of different tocopherol forms and CaP aggressiveness have yet to be examined. METHODS This study examined whether food intake of tocopherols, vitamin E supplement use, and adipose tissue biomarkers of tocopherol were associated with CaP aggressiveness among African-American (AA, n = 1,023) and European-American (EA, n = 1,079) men diagnosed with incident CaP. Dietary tocopherols were estimated from a food frequency questionnaire, supplement use from questionnaire/inventory, and biomarkers from abdominal adipose samples measured using high-performance liquid chromatography. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated from logistic regression comparing high-aggressive CaP to low/intermediate aggressive CaP, adjusting for covariates. RESULTS Dietary intakes of α-and δ-tocopherol were related inversely to CaP aggressiveness among EAs [OR (95%CI), highest versus lowest quartile: α-tocopherol, 0.34 (0.17-0.69), P(trend) = 0.006; δ-tocopherol, 0.45 (0.21-0.95) P(trend) = 0.007]. Inverse associations between dietary and supplemental α-tocopherol and CaP aggressiveness were observed among AAs, though these did not reach statistical significance [OR (95%CI), highest versus lowest quartile: dietary α-tocopherol, 0.58 (0.28-1.19), P(trend) = 0.20; supplemental α-tocopherol, 0.64 (0.31-1.21) P(trend) = 0.15]. No significant association was observed between adipose tocopherol levels and CaP aggressiveness [OR (95%CI), highest versus lowest quartiles of α-tocopherol for EAs 1.43 (0.66-3.11) and AAs 0.66 (0.27-1.62)]. CONCLUSIONS The inverse associations observed between dietary sources of tocopherols and CaP aggressiveness suggests a beneficial role of food sources of these tocopherols in CaP aggressiveness.
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Affiliation(s)
- Samuel Antwi
- Division of Epidemiology, Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Susan E. Steck
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - L. Joseph Su
- National Cancer Institute, National Institutes of Health, Rockville, MD
| | - James R. Hebert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Hongmei Zhang
- Department of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, Memphis, TN
| | | | - Gary Smith
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Jeannette T. Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - James L. Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Lenore Arab
- David Geffen School of Medicine at UCLA, Los Angeles, CA
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Thioredoxin 1 in Prostate Tissue Is Associated with Gleason Score, Erythrocyte Antioxidant Enzyme Activity, and Dietary Antioxidants. Prostate Cancer 2015; 2015:728046. [PMID: 26357575 PMCID: PMC4556330 DOI: 10.1155/2015/728046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022] Open
Abstract
Background. Prostate cancer is the most common noncutaneous cancer and second leading cause of cancer-related mortality in men in the US. Growing evidence suggests that oxidative stress is involved in prostate cancer. Methods. In this study, thioredoxin 1 (Trx 1), an enzyme and subcellular indicator of redox status, was measured in prostate biopsy tissue from 55 men from the North Carolina-Louisiana Prostate Cancer Project. A pathologist blindly scored levels of Trx 1. The association between Trx 1 and the Gleason score, erythrocyte antioxidant enzyme activity, and dietary antioxidant intake was determined using Fisher's exact test. Results. Trx 1 levels in benign prostate tissue in men with incident prostate cancer were positively associated with the Gleason score (P = 0.01) and inversely associated with dietary antioxidant intake (P = 0.03). In prostate cancer tissue, Trx 1 levels were associated with erythrocyte glutathione peroxidase activity (P = 0.01). No association was found for other erythrocyte enzymes. Greater Gleason score of malignant tissue corresponds to a greater difference in Trx 1 levels between malignant and benign tissue (P = 0.04). Conclusion. These results suggest that the redox status of prostate tissue is associated with prostate cancer grade and both endogenous and exogenous antioxidants.
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Gu CY, Li QX, Zhu Y, Wang MY, Shi TY, Yang YY, Wang JC, Jin L, Wei QY, Ye DW. Genetic variations of the ADIPOQgene and risk of prostate cancer in Chinese Han men. Asian J Androl 2015; 16:878-83. [PMID: 25038177 PMCID: PMC4236333 DOI: 10.4103/1008-682x.129939] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adiponectin secreted by adipose tissue has been implicated in prostate carcinogenesis. Genetic variations in ADIPOQ are thought to influence the activity of adiponectin, thus relating to cancer occurrence. In this hospital-based case-control study of 917 prostate cancer (PCa) cases and 1036 cancer-free controls, we evaluated the association of single nucleotide polymorphisms in ADIPOQ with risk of PCa and adiponectin levels in Chinese Han men. Variants of ADIPOQ were genotyped by Taqman polymerase chain reaction method. The plasma adiponectin concentrations were measured by enzyme-linked immunosorbent assay (ELISA) in a subset of cases and controls. We found that the ADIPOQ rs3774262 variant AA genotype was associated with both decreased PCa risk [adjusted odds ratio (OR): 0.66, 95% confidence interval (CI) =0.48–0.92] and increased plasma adiponectin levels (P = 0.036 and 0.043), with significant difference by tumor grade, clinical stage, and aggressiveness. A significant interaction between ADIPOQ rs3774262 and body mass index was observed in modifying the risk of PCa (P = 6.7 × 10−3). ADIPOQ rs266729 and rs182052 were not related to PCa risk or plasma adiponectin levels. Our data support that ADIPOQ rs3774262 may affect PCa risk in combination with plasma adiponectin levels in Chinese Han men. It may contribute to the molecular basis for the association between obesity and PCa.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Qing-Yi Wei
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA, China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, China
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Li Q, Gu C, Zhu Y, Wang M, Yang Y, Wang J, Jin L, Zhu ML, Shi TY, He J, Ye D, Wei Q. Two novel PRKCI polymorphisms and prostate cancer risk in an Eastern Chinese Han population. Mol Carcinog 2015; 54:632-41. [PMID: 24510606 DOI: 10.1002/mc.22130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/05/2013] [Accepted: 12/19/2013] [Indexed: 02/05/2023]
Abstract
The atypical protein kinase C (aPKCι), encoded by the PRKCI gene, has been recently found to be a unique human oncoprotein, compared with some other diverse PKC isozymes. Genetic variations in PRKCI have also been reported to be associated with prostate cancer (PCa) risk in Caucasian populations, but no similar studies have been reported for Chinese populations. We genotyped two well-described PRKCI single nucleotide polymorphisms (SNPs) rs546950 and rs4955720 in 1015 PCa patients and 1044 cancer-free controls of Eastern Chinese men. SNPs in the vicinity of those two variants of PRKCI were evaluated using the in silico analysis. Logistic regression was then used to estimate their associations with and interactions in PCa risk. Although no significant main effects were found for the two tested SNPs in the single locus analysis, individuals carrying homozygote wide-type form of these two SNPs had slightly reduced PCa risk (adjusted OR = 0.63, 95% CI = 0.40-0.99, P = 0.045), compared with those carrying any of heterozygous or homozygous variant genotypes. Our results indicated that the two PRKCI SNPs were jointly associated with PCa risk in an Eastern Chinese population. Larger studies with multiethnic groups are warranted to confirm these findings and to explore the role of PRKCI SNPs in the etiology of PCa.
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Affiliation(s)
- Qiaoxin Li
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chengyuan Gu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yao Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mengyun Wang
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yajun Yang
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
- Fudan-Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Jiucun Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
- Fudan-Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Li Jin
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
- Fudan-Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Mei-Ling Zhu
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ting-Yan Shi
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing He
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qingyi Wei
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
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Steck SE, Arab L, Zhang H, Bensen JT, Fontham ETH, Johnson CS, Mohler JL, Smith GJ, Su JL, Trump DL, Woloszynska-Read A. Association between Plasma 25-Hydroxyvitamin D, Ancestry and Aggressive Prostate Cancer among African Americans and European Americans in PCaP. PLoS One 2015; 10:e0125151. [PMID: 25919866 PMCID: PMC4412567 DOI: 10.1371/journal.pone.0125151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/10/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND African Americans (AAs) have lower circulating 25-hydroxyvitamin D3 [25(OH)D3] concentrations and higher prostate cancer (CaP) aggressiveness than other racial/ethnic groups. The purpose of the current study was to examine the relationship between plasma 25(OH)D3, African ancestry and CaP aggressiveness among AAs and European Americans (EAs). METHODS Plasma 25(OH)D3 was measured using LC-MS/MS (Liquid Chromatography Tandem Mass Spectrometry) in 537 AA and 663 EA newly-diagnosed CaP patients from the North Carolina-Louisiana Prostate Cancer Project (PCaP) classified as having either 'high' or 'low' aggressive disease based on clinical stage, Gleason grade and prostate specific antigen at diagnosis. Mean plasma 25(OH)D3 concentrations were compared by proportion of African ancestry. Logistic regression was used to calculate multivariable adjusted odds ratios (OR) and 95% confidence intervals (95%CI) for high aggressive CaP by tertile of plasma 25(OH)D3. RESULTS AAs with highest percent African ancestry (>95%) had the lowest mean plasma 25(OH)D3 concentrations. Overall, plasma 25(OH)D3 was associated positively with aggressiveness among AA men, an association that was modified by calcium intake (ORT 3vs.T1: 2.23, 95%CI: 1.26-3.95 among men with low calcium intake, and ORT 3vs.T1: 0.19, 95%CI: 0.05-0.70 among men with high calcium intake). Among EAs, the point estimates of the ORs were <1.0 for the upper tertiles with CIs that included the null. CONCLUSIONS Among AAs, plasma 25(OH)D3 was associated positively with CaP aggressiveness among men with low calcium intake and inversely among men with high calcium intake. The clinical significance of circulating concentrations of 25(OH)D3 and interactions with calcium intake in the AA population warrants further study.
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Affiliation(s)
- Susan E. Steck
- Department of Epidemiology and Biostatistics, Center for Research in Nutrition and Health Disparities, Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Lenore Arab
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hongmei Zhang
- University of Memphis, Memphis, Tennessee, United States of America
| | - Jeannette T. Bensen
- Department of Epidemiology, Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Elizabeth T. H. Fontham
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Candace S. Johnson
- Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - James L. Mohler
- Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - Gary J. Smith
- Roswell Park Cancer Institute, Buffalo, New York, United States of America
| | - Joseph L. Su
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Donald L. Trump
- Roswell Park Cancer Institute, Buffalo, New York, United States of America
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Morris BB, Farnan L, Song L, Addington EL, Chen RC, Nielsen ME, Mishel M, Mohler JL, Bensen JT. Treatment decisional regret among men with prostate cancer: Racial differences and influential factors in the North Carolina Health Access and Prostate Cancer Treatment Project (HCaP-NC). Cancer 2015; 121:2029-35. [PMID: 25740564 DOI: 10.1002/cncr.29309] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/11/2015] [Accepted: 01/26/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND It has been demonstrated that treatment decisional regret affects quality of life in patients with prostate cancer (CaP); however, there are limited studies that identify factors associated with treatment decisional regret, particularly within a racially diverse patient population that has extended follow-up. METHODS Logistic regression analysis was used to determine associations between decisional regret and potential predictors in a population-based cohort of 348 African American men and 446 Caucasian American men approximately 3 years after CaP diagnosis. RESULTS Of 794 research participants, 12% experienced treatment decisional regret. Decisional regret was associated with androgen-deprivation therapy (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.1-4.0), recent urinary bother (OR, 3.4; 95% CI, 1.6-7.3), satisfaction with understanding potential treatment side effects (very unsatisfied: OR, 13.3; 95% CI, 5.5-32.2; somewhat unsatisfied: OR, 5.0; 95% CI, 2.3-11.2; neutral: OR, 3.8; 95% CI, 1.9-7.6), and CaP treatment effect on the spousal relationship (very affected: OR, 3.9; 95% CI, 2.0-7.6; somewhat affected: OR, 3.1; 95% CI, 1.4-7.3; neutral: OR, 2.4; 95% CI, 1.9-7.6). Younger African Americans were more likely to experience regret than older African Americans (OR, 3.0; 95% CI, 1.1-8.1), and older African Americans were less likely to experience regret than older Caucasian Americans (OR, 0.2; 95% CI, 0.1-0.7). CONCLUSIONS Treatment decisional regret remains an important issue in CaP survivors beyond initial treatment. Potential interventions should involve younger African Americans and patient spouses. Increased regret may reflect the unexpected influence of treatment side effects on the patient's everyday life; helping the patient relate potential side effects to his individual situation could improve patient satisfaction.
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Affiliation(s)
- Bonny B Morris
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Baptist Hospital Comprehensive Cancer Center, Wake Forest University, Winston-Salem, North Carolina
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lixin Song
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth L Addington
- Clinical Health Psychology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Ronald C Chen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E Nielsen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Surgery/Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Merle Mishel
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James L Mohler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Surgery/Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.,Department of Urology, University of Buffalo School of Medicine and Biotechnology, Buffalo, New York
| | - Jeannette T Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Spratt DE, Osborne JR. Disparities in castration-resistant prostate cancer trials. J Clin Oncol 2015; 33:1101-3. [PMID: 25691679 DOI: 10.1200/jco.2014.58.1751] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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38
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Song L, Weaver MA, Chen RC, Bensen JT, Fontham E, Mohler JL, Mishel M, Godley PA, Sleath B. Associations between patient-provider communication and socio-cultural factors in prostate cancer patients: a cross-sectional evaluation of racial differences. PATIENT EDUCATION AND COUNSELING 2014; 97:339-46. [PMID: 25224313 PMCID: PMC4252656 DOI: 10.1016/j.pec.2014.08.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 07/30/2014] [Accepted: 08/26/2014] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To examine the association between socio-cultural factors and patient-provider communication and related racial differences. METHODS Data analysis included 1854 men with prostate cancer from a population-based study. Participants completed an assessment of communication variables, physician trust, perceived racism, religious beliefs, traditional health beliefs, and health literacy. A multi-group structural equation modeling approach was used to address the research aims. RESULTS Compared with African Americans, Caucasian Americans had significantly greater mean scores of interpersonal treatment (p<0.01), prostate cancer communication (p<0.001), and physician trust (p<0.001), but lower mean scores of religious beliefs, traditional health beliefs, and perceived racism (all p values <0.001). For both African and Caucasian Americans, better patient-provider communication was associated with more physician trust, less perceived racism, greater religious beliefs (all p-values <0.01), and at least high school education (p<0.05). CONCLUSION Socio-cultural factors are associated with patient-provider communication among men with cancer. No evidence supported associations differed by race. PRACTICE IMPLICATION To facilitate patient-provider communication during prostate cancer care, providers need to be aware of patient education levels, engage in behaviors that enhance trust, treat patients equally, respect religious beliefs, and reduce the difficulty level of the information.
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Affiliation(s)
- Lixin Song
- School of Nursing, University of North Carolina, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA.
| | - Mark A Weaver
- School of Medicine, University of North Carolina, Chapel Hill, USA
| | - Ronald C Chen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; School of Medicine, University of North Carolina, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, USA
| | - Jeannette T Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; School of Public Health, University of North Carolina, Chapel Hill, USA
| | - Elizabeth Fontham
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, USA
| | - James L Mohler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; Department of Urology, Roswell Park Cancer Institute, Buffalo, USA
| | - Merle Mishel
- School of Nursing, University of North Carolina, Chapel Hill, USA
| | - Paul A Godley
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; School of Medicine, University of North Carolina, Chapel Hill, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, USA
| | - Betsy Sleath
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
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Meyer AM, Wheeler SB, Weinberger M, Chen RC, Carpenter WR. An Overview of Methods for Comparative Effectiveness Research. Semin Radiat Oncol 2014; 24:5-13. [DOI: 10.1016/j.semradonc.2013.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bensen JT, Xu Z, McKeigue PM, Smith GJ, Fontham ET, Mohler JL, Taylor JA. Admixture mapping of prostate cancer in African Americans participating in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Prostate 2014; 74:1-9. [PMID: 24037755 PMCID: PMC3934014 DOI: 10.1002/pros.22722] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/22/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few genetic risk factors have been uncovered that contribute specifically to the racial disparity in prostate cancer (CaP) observed in African Americans (AA). With the advent of ancestry informative marker (AIM) single nucleotide polymorphism (SNP) panels and powerful genetic strategies such as mapping by admixture linkage disequilibrium (MALD) it is possible to discover genes that underlie ethnic variation in disease risk. METHODS One thousand one hundred thirty AA CaP cases enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP) were genotyped using a 1,509 AIM SNP panel. MALD was performed using ADMIXMAP to test for linkage between CaP risk and ancestry estimates at each AIM SNP. RESULTS The largest increase of African ancestry was observed at marker rs12543473 (P = 0.0011), located on chromosome 8q24.21, and the greatest excess of European ancestry was observed at marker rs10768140 (P = 0.0004) at chromosome 11p13. CONCLUSIONS The study confirmed the 8q24 risk loci and identified a novel genomic region on 11p13 that is associated with CaP risk. These findings should be replicated in larger AA populations and combined with fine mapping data to further refine the novel 11p13 CaP risk loci.
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Affiliation(s)
- Jeannette T. Bensen
- Department of Epidemiology University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
- Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
| | - Zongli Xu
- Epidemiology Branch National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709 National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709
| | - Paul M. McKeigue
- Center for Population Health Sciences, University of Edinburgh Medical School, Tevoit Place, Edinburgh , United Kingdom
| | - Gary J. Smith
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York 14263
| | - Elizabeth T.H. Fontham
- School of Public Health, Louisiana State University Health Science Center, New Orleans, Louisiana 70112
| | - James L. Mohler
- Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
- Department of Surgery, Division of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York 14263
- Department of Urology, University of Buffalo School of Medicine and Biotechnology, Buffalo, New York, 14214
| | - Jack A. Taylor
- Epidemiology Branch National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709 National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709
- Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709
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Moore AD, Hamilton JB, Knafl GJ, Godley PA, Carpenter WR, Bensen JT, Mohler JL, Mishel M. The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project. J Natl Med Assoc 2013; 105:59-68. [PMID: 23862297 DOI: 10.1016/s0027-9684(15)30086-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American men's use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes. METHODS This descriptive correlation study examined relationships of individual characteristics that influence patient satisfaction using data from 505 African American men from North Carolina, who prospectively enrolled in the North Carolina-Louisiana Prostate Cancer Project from September 2004 to November 2007. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression analysis. RESULTS The variables selected for the final model were: participation in religious activities, mistrust, racism, and perceived access to care. In this study, both cultural variables, mistrust (p=<.0001, F=95.58) and racism (p=<.002, F=5.59), were significantly negatively associated with patient satisfaction and accounted for the majority of the variability represented by individual characteristics. CONCLUSION Mistrust and racism are cultural factors that are extremely important and have been negatively associated with patient satisfaction and decreased desires to utilize health care services for African American men. To overcome barriers in seeking health care services, health care providers need to implement a patient-centered approach by creating a clinical environment that demonstrates cultural competence and eliminating policies, procedures, processes, or personnel that foster mistrust and racism.
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Affiliation(s)
- Angelo D Moore
- US Army, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA.
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Arab L, Su J, Steck SE, Ang A, Fontham ETH, Bensen JT, Mohler JL. Adherence to World Cancer Research Fund/American Institute for Cancer Research Lifestyle Recommendations Reduces Prostate Cancer Aggressiveness Among African and Caucasian Americans. Nutr Cancer 2013; 65:633-43. [DOI: 10.1080/01635581.2013.789540] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Poch MA, Mehedint D, Green DJ, Payne-Ondracek R, Fontham ET, Bensen JT, Attwood K, Wilding GE, Guru KA, Underwood W, Mohler JL, Heemers HV. The association between calcium channel blocker use and prostate cancer outcome. Prostate 2013; 73:865-72. [PMID: 23280547 PMCID: PMC5826547 DOI: 10.1002/pros.22632] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Epidemiological studies indicate that calcium channel blocker (CCB) use is inversely related to prostate cancer (PCa) incidence. The association between CCB use and PCa aggressiveness at the time of radical prostatectomy (RP) and outcome after RP was examined. METHODS Medication use, PCa aggressiveness and post-RP outcome were retrieved from a prospectively populated database that contains clinical and outcome for RP patients at Roswell Park Cancer Institute (RPCI) from 1993 to 2010. The database was queried for anti-hypertensive medication use at diagnosis for patients with ≥1 year follow-up. Recurrence was defined using NCCN guidelines. Chi-Square tests assessed the relationship between CCB use and PCa aggressiveness. Cox regression models compared the distribution of progression-free survival (PFS) and overall survival (OS) with adjustment for covariates. Results for association between CCB usage and PCa aggressiveness were validated using data from the population-based North Carolina-Louisiana Prostate Cancer Project (PCaP). RESULTS 48%, 37%, and 15% of RPCI's RP patients (n = 875) had low, intermediate, and high aggressive PCa, respectively. 104 (11%) had a history of CCB use. Patients taking CCBs were more likely to be older, have a higher BMI and use additional anti-hypertensive medications. Diagnostic PSA levels, PCa aggressiveness, and margin status were similar for CCB users and non-users. PFS and OS did not differ between the two groups. Tumor aggressiveness was associated with PFS. CCB use in the PCaP study population was not associated with PCa aggressiveness. CONCLUSIONS CCB use is not associated with PCa aggressiveness at diagnosis, PFS or OS.
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Affiliation(s)
- Michael A. Poch
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Diana Mehedint
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Dawn J. Green
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Rochelle Payne-Ondracek
- Department of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York
| | - Elizabeth T.H. Fontham
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Gregory E. Wilding
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Khurshid A. Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - James L. Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Hannelore V. Heemers
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
- Correspondence to: Hannelore V. Heemers, Department of Urology, Roswell Park Cancer Institute, Cell and Virus Annex, Rooms 142-144, Elm & Carlton Streets, Buffalo, NY 14263.
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Ellis SD, Blackard B, Carpenter WR, Mishel M, Chen RC, Godley PA, Mohler JL, Bensen JT. Receipt of National Comprehensive Cancer Network guideline-concordant prostate cancer care among African American and Caucasian American men in North Carolina. Cancer 2013; 119:2282-90. [PMID: 23575751 DOI: 10.1002/cncr.28004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/27/2012] [Accepted: 10/08/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND African Americans have a higher incidence of prostate cancer and experience poorer outcomes compared with Caucasian Americans. Racial differences in care are well documented; however, few studies have characterized patients based on their prostate cancer risk category, which is required to differentiate appropriate from inappropriate guideline application. METHODS The medical records of a population-based sample of 777 North Carolina men with newly diagnosed prostate cancer were studied to assess the association among patient race, clinical factors, and National Comprehensive Cancer Network (NCCN) guideline-concordant prostate cancer care. RESULTS African Americans presented with significantly higher Gleason scores (P = .025) and prostate-specific antigen levels (P = .008) than did Caucasian Americans. However, when clinical T stage was considered as well, difference in overall risk category only approached statistical significance (P = .055). Across risk categories, African Americans were less likely to have surgery (58.1% versus 68.0%, P = .004) and more likely to have radiation (39.0% versus 27.4%, P = .001) compared with Caucasian Americans. However, 83.5% of men received guideline-concordant care within 1 year of diagnosis, which did not differ by race in multivariable analysis (odds ratio = 0.83; 95% confidence interval = 0.54-1.25). Greater patient-perceived access to care was associated with greater odds of receiving guideline-concordant care (odds ratio = 1.06; 95% confidence interval = 1.01-1.12). CONCLUSIONS After controlling for NCCN risk category, there were no racial differences in receipt of guideline-concordant care. Efforts to improve prostate cancer treatment outcomes should focus on improving access to the health care system.
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Affiliation(s)
- Shellie D Ellis
- School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7411, USA.
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Song L, Bensen JT, Zimmer C, Sleath B, Blackard B, Fontham E, Su LJ, Brennan CS, Mohler JL, Mishel M. Patient-health care provider communication among patients with newly diagnosed prostate cancer: findings from a population-based survey. PATIENT EDUCATION AND COUNSELING 2013; 91:79-84. [PMID: 23332967 PMCID: PMC4238380 DOI: 10.1016/j.pec.2012.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 11/09/2012] [Accepted: 12/01/2012] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine the multidimensional concept of patient-health care provider (HCP) communication, its effects on patient satisfaction with oncology care services, and related racial differences. METHODS The current analysis draws from a population-based survey sample of 1011 African American and 1034 Caucasian American men with newly diagnosed prostate cancer. The variables of satisfaction with health care services, interpersonal treatment, contextual knowledge of the patient, and prostate cancer communication were analyzed using multiple-group structural equation modeling. RESULTS Regardless of race, patient-HCP communication was related positively to interpersonal treatment by the HCP, HCP's contextual knowledge of the patient, and prostate cancer communication. More positive patient-HCP communication was related to more satisfaction with health care services. Racial differences were significant in the relationships between patient-HCP communication and prostate cancer communication. CONCLUSION Content and interpersonal relationships are important aspects of patient-HCP communication and affect patient satisfaction with oncologic care for prostate cancer. PRACTICE IMPLICATIONS HCPs need to integrate the transfer of information with emotional support and interpersonal connection when they communicate with men with newly diagnosed prostate cancer.
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Affiliation(s)
- Lixin Song
- School of Nursing, University of North Carolina, Chapel Hill, USA.
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Song L, Chen RC, Bensen JT, Knafl GJ, Nielsen ME, Farnan L, Wallen EM, Mishel M, Pruthi RS, Mohler JL, Godley PA. Who makes the decision regarding the treatment of clinically localized prostate cancer--the patient or physician?: results from a population-based study. Cancer 2013; 119:421-8. [PMID: 22786794 PMCID: PMC7671233 DOI: 10.1002/cncr.27738] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/09/2012] [Accepted: 06/04/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current study examined how patients' sociodemographic, cancer-related, and subjective affective factors impacted their role in treatment decision-making. METHODS The patient sample (N = 788) was taken from a prospective follow-up study of a population-based cohort. Participants included 343 African American and 445 Caucasian-American patients with clinically localized prostate cancer. Multinomial logistic regression was used to investigate relations between the explanatory variables and the nominal 3-level decision-making variable: patient-only, patient-physician shared, and physician-only. RESULTS Approximately 41% of patients reported patient-only decision-making, 45% reported shared decision-making, and 13% reported physician-only decision-making. The odds of patient-only over physician-only decision-making were greater for younger men (vs those aged ≥ 65 years) (odds ratio [OR], 1.68; 95% confidence interval [95% CI], 1.03-2.74), and were less for men with high (vs low) cancer aggressiveness (OR,0.29; 95% CI, 0.15-0.55). The odds of shared over physician-only decision-making were less for men with high (vs low) cancer aggressiveness (OR, 0.40; 95% CI, 0.22-0.73). Greater odds of patient-only and shared decision-making also were found to be associated with greater concerns about the physical impact of treatment and having enough time for decision-making and lower scores of receiving advice from others. CONCLUSIONS The findings of the current study indicate that, to facilitate a more patient-oriented decision-making process regarding treatment in those with clinically localized prostate cancer, clinicians need to tailor their interventions according to patient age and cancer aggressiveness, help reduce patient concerns and misconceptions regarding the physical impact of treatments, allow sufficient time for patients to consider treatment options, and assist patients in balancing advice and information received from different sources.
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Affiliation(s)
- Lixin Song
- Adult and Geriatric Health Division, School of Nursing, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7460, USA.
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Bensen JT, Xu Z, Smith GJ, Mohler JL, Fontham ET, Taylor JA. Genetic polymorphism and prostate cancer aggressiveness: a case-only study of 1,536 GWAS and candidate SNPs in African-Americans and European-Americans. Prostate 2013; 73:11-22. [PMID: 22549899 PMCID: PMC3480543 DOI: 10.1002/pros.22532] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/10/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Genome-wide association studies have established a number of replicated single nucleotide polymorphisms (SNPs) for susceptibility to prostate cancer (CaP), but it is unclear whether these susceptibility SNPs are also associated with disease aggressiveness. This study evaluates whether such replication SNPs or other candidate SNPs are associated with CaP aggressiveness in African-American (AA) and European-American (EA) men. METHODS A 1,536 SNP panel which included 34 genome-wide association study (GWAS) replication SNPs, 38 flanking SNPs, a set of ancestry informative markers, and SNPs in candidate genes and other areas was genotyped in 1,060 AA and 1,087 EA men with incident CaP from the North Carolina-Louisiana Prostate Cancer Project (PCaP). Tests for association were conducted using ordinal logistic regression with a log-additive genotype model and a 3-category CaP aggressiveness variable. RESULTS Four GWAS replication SNPs (rs2660753, rs13254738, rs10090154, rs2735839) and seven flanking SNPs were associated with CaP aggressiveness (P < 0.05) in three genomic regions: One at 3p12 (EA), seven at 8q24 (5 AA, 2 EA), and three at 19q13 at the kallilkrein-related peptidase 3 (KLK3) locus (two AA, one AA and EA). The KLK3 SNPs also were associated with serum prostate-specific antigen (PSA) levels in AA (P < 0.001) but not in EA. A number of the other SNPs showed some evidence of association but none met study-wide significance levels after adjusting for multiple comparisons. CONCLUSIONS Some replicated GWAS susceptibility SNPs may play a role in CaP aggressiveness. However, like susceptibility, these associations are not consistent between racial groups.
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Affiliation(s)
- Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
| | - Zongli Xu
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709
| | - Gary J. Smith
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York 14263
| | - James L. Mohler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York 14263
- Department of Urology, University of Buffalo School of Medicine and Biotechnology, Buffalo, New York, 14214
- Department of Surgery, Division of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435
| | - Elizabeth T.H. Fontham
- Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana 70112
| | - Jack A. Taylor
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709
- Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709
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Intake of grains and dietary fiber and prostate cancer aggressiveness by race. Prostate Cancer 2012; 2012:323296. [PMID: 23213538 PMCID: PMC3503404 DOI: 10.1155/2012/323296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 10/12/2012] [Indexed: 12/04/2022] Open
Abstract
Purpose. To examine the associations among intake of refined grains, whole grains and dietary fiber and aggressiveness of prostate cancer in African Americans (AA, n = 930) and European Americans (EA, n = 993) in a population-based, case-only study (The North Carolina-Louisiana Prostate Cancer Project, PCaP). Methods. Prostate cancer aggressiveness was categorized as high, intermediate or low based on Gleason grade, PSA level and clinical stage. Dietary intake was assessed utilizing the NCI Diet History Questionnaire. Logistic regression (comparing high to intermediate/low aggressive cancers) and polytomous regression with adjustment for potential confounders were used to determine odds of high prostate cancer aggressiveness with intake of refined grains, whole grains and dietary fiber from all sources. Results. An inverse association with aggressive prostate cancer was observed in the 2nd and 3rd tertiles of total fiber intake (OR = 0.70; 95% CI, 0.50–0.97 and OR = 0.61; 95% CI, 0.40–0.93, resp.) as compared to the lowest tertile of intake. In the race-stratified analyses, inverse associations were observed in the 3rd tertile of total fiber intake for EA (OR = 0.44; 95% CI, 0.23–0.87) and the 2nd tertile of intake for AA (OR = 0.57; 95% CI, 0.35–0.95). Conclusions. Dietary fiber intake was inversely associated with aggressive prostate cancer among both AA and EA men.
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Koochekpour S, Majumdar S, Azabdaftari G, Attwood K, Scioneaux R, Subramani D, Manhardt C, Lorusso GD, Willard SS, Thompson H, Shourideh M, Rezaei K, Sartor O, Mohler JL, Vessella RL. Serum glutamate levels correlate with Gleason score and glutamate blockade decreases proliferation, migration, and invasion and induces apoptosis in prostate cancer cells. Clin Cancer Res 2012; 18:5888-901. [PMID: 23072969 DOI: 10.1158/1078-0432.ccr-12-1308] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE During glutaminolysis, glutamine is catabolized to glutamate and incorporated into citric acid cycle and lipogenesis. Serum glutamate levels were measured in patients with primary prostate cancer or metastatic castrate-resistant prostate cancer (mCRPCa) to establish clinical relevance. The effect of glutamate deprivation or blockade by metabotropic glutamate receptor 1 (GRM1) antagonists was investigated on prostate cancer cells' growth, migration, and invasion to establish biologic relevance. EXPERIMENTAL DESIGN Serum glutamate levels were measured in normal men (n = 60) and patients with primary prostate cancer (n = 197) or mCRPCa (n = 109). GRM1 expression in prostatic tissues was examined using immunohistochemistry (IHC). Cell growth, migration, and invasion were determined using cell cytotoxicity and modified Boyden chamber assays, respectively. Apoptosis was detected using immunoblotting against cleaved caspases, PARP, and γ-H2AX. RESULTS Univariate and multivariate analyses showed significantly higher serum glutamate levels in Gleason score ≥ 8 than in the Gleason score ≤ 7 and in African Americans than in the Caucasian Americans. African Americans with mCRPCa had significantly higher serum glutamate levels than those with primary prostate cancer or benign prostate. However, in Caucasian Americans, serum glutamate levels were similar in normal research subjects and patients with mCRPC. IHC showed weak or no expression of GRM1 in luminal acinar epithelial cells of normal or hyperplastic glands but high expression in primary or metastatic prostate cancer tissues. Glutamate deprivation or blockade decreased prostate cancer cells' proliferation, migration, and invasion and led to apoptotic cell death. CONCLUSIONS Glutamate expression is mechanistically associated with and may provide a biomarker of prostate cancer aggressiveness.
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Affiliation(s)
- Shahriar Koochekpour
- Department of Cancer Genetics, Center for Genetics and Pharmacology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Moore AD, Hamilton JB, Knafl GJ, Godley PA, Carpenter WR, Bensen JT, Mohler JL, Mishel M. Patient Satisfaction Influenced by interpersonal treatment and communication for African American men: the North Carolina-Louisiana Prostate Cancer Project (PCaP). Am J Mens Health 2012; 6:409-19. [PMID: 22833311 DOI: 10.1177/1557988312443695] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine if a particular set of health behaviors of health care providers and African American men (AAM) influence patient satisfaction from the AAM's perspective. This descriptive, correlational study consisted of 505 AAM in North Carolina diagnosed with prostate cancer and enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Analyses consisted of bivariate analyses and multiple regression. Patient-to-provider communication, interpersonal treatment, and provider-to-patient communication accounted for 45% (p ≤ .0001) of the variability in patient satisfaction. Interpersonal treatment (provider focusing on the patient) explained the greatest amount (F = 313.53, R² = .39) of patient satisfaction. Since interpersonal treatment focuses on the patient and demonstrated to be the strongest predictor in patient satisfaction, it is noteworthy to consider the emphasis that should be placed on patient-centered care. In addition, knowing important variables positively affecting patient satisfaction provides useful information for developing appropriate interventions to improve AAM health care experiences.
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Affiliation(s)
- Angelo D Moore
- U.S Army, Tripler Army Medical Center, Honolulu, HI, USA.
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