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El Khoury CJ. Application of Geographic Information Systems (GIS) in the Study of Prostate Cancer Disparities: A Systematic Review. Cancers (Basel) 2024; 16:2715. [PMID: 39123443 PMCID: PMC11312136 DOI: 10.3390/cancers16152715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Introduction: PCa is one of the cancers that exhibits the widest disparity gaps. Geographical place of residence has been shown to be associated with healthcare access/utilization and PCa outcomes. Geographical Information Systems (GIS) are widely being utilized for PCa disparities research, however, inconsistencies in their application exist. This systematic review will summarize GIS application within PCa disparities research, highlight gaps in the literature, and propose alternative approaches. Methods: This paper followed the methods of the Cochrane Collaboration and the criteria set of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles published in peer-reviewed journals were searched through the PubMed, Embase, and Web of Science databases until December 2022. The main inclusion criteria were employing a GIS approach and examining a relationship between geographical components and PCa disparities. The main exclusion criteria were studies conducted outside the US and those that were not published in English. Results: A total of 25 articles were included; 23 focused on PCa measures as outcomes: incidence, survival, and mortality, while only 2 examined PCa management. GIS application in PCa disparities research was grouped into three main categories: mapping, processing, and analysis. GIS mapping allowed for the visualization of quantitative, qualitative, and temporal trends of PCa factors. GIS processing was mainly used for geocoding and smoothing of PCa rates. GIS analysis mainly served to evaluate global spatial autocorrelation and distribution of PCa cases, while local cluster identification techniques were mainly employed to identify locations with poorer PCa outcomes, soliciting public health interventions. Discussion: Varied GIS applications and methodologies have been used in researching PCa disparities. Multiple geographical scales were adopted, leading to variations in associations and outcomes. Geocoding quality varied considerably, leading to less robust findings. Limitations in cluster-detection approaches were identified, especially when variations were captured using the Spatial Scan Statistic. GIS approaches utilized in other diseases might be applied within PCa disparities research for more accurate inferences. A novel approach for GIS research in PCa disparities could be focusing more on geospatial disparities in procedure utilization especially when it comes to PCa screening techniques. Conclusions: This systematic review summarized and described the current state and trend of GIS application in PCa disparities research. Although GIS is of crucial importance when it comes to PCa disparities research, future studies should rely on more robust GIS techniques, carefully select the geographical scale studied, and partner with GIS scientists for more accurate inferences. Such interdisciplinary approaches have the potential to bridge the gaps between GIS and cancer prevention and control to further advance cancer equity.
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Affiliation(s)
- Christiane J. El Khoury
- Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY 11790, USA; ; Tel.: +1-718-970-0177
- Department of Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center at Thomas Jefferson University, Philadelphia, PA 19107, USA
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Acosta-Vega NL, Varela R, Mesa JA, Garai J, Gómez-Gutiérrez A, Serrano-Gómez SJ, Zabaleta J, Sanabria-Salas MC, Combita AL. Genetic ancestry and radical prostatectomy findings in Hispanic/Latino patients. Front Oncol 2024; 14:1338250. [PMID: 38634046 PMCID: PMC11021589 DOI: 10.3389/fonc.2024.1338250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background African ancestry is a known factor associated with the presentation and aggressiveness of prostate cancer (PC). Hispanic/Latino populations exhibit varying degrees of genetic admixture across Latin American countries, leading to diverse levels of African ancestry. However, it remains unclear whether genetic ancestry plays a role in the aggressiveness of PC in Hispanic/Latino patients. We explored the associations between genetic ancestry and the clinicopathological data in Hispanic/Latino PC patients from Colombia. Patients and methods We estimated the European, Indigenous and African genetic ancestry, of 230 Colombian patients with localized/regionally advanced PC through a validated panel for genotypification of 106 Ancestry Informative Markers. We examined the associations of the genetic ancestry components with the Gleason Grade Groups (GG) and the clinicopathological characteristics. Results No association was observed between the genetic ancestry with the biochemical recurrence or Gleason GG; however, in a two groups comparison, there were statistically significant differences between GG3 and GG4/GG5 for European ancestry, with a higher mean ancestry proportion in GG4/GG5. A lower risk of being diagnosed at an advanced age was observed for patients with high African ancestry than those with low African ancestry patients (OR: 0.96, CI: 0.92-0.99, p=0.03). Conclusion Our findings revealed an increased risk of presentation of PC at an earlier age in patients with higher African ancestry compared to patients with lower African ancestry in our Hispanic/Latino patients.
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Affiliation(s)
- Natalia L. Acosta-Vega
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
- Programa de doctorado en Ciencias Biológicas, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Rodolfo Varela
- Departamento de Urología, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - Jorge Andrés Mesa
- Departamento de Patología Oncológica, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
| | - Jone Garai
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Alberto Gómez-Gutiérrez
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Silvia J. Serrano-Gómez
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
| | - Jovanny Zabaleta
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- Department of Interdisciplinary Oncology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - María Carolina Sanabria-Salas
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
| | - Alba L. Combita
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
- Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C., Colombia
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El Khoury CJ, Clouston SAP. Racial/Ethnic Disparities in Prostate Cancer 5-Year Survival: The Role of Health-Care Access and Disease Severity. Cancers (Basel) 2023; 15:4284. [PMID: 37686560 PMCID: PMC10486477 DOI: 10.3390/cancers15174284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Prostate cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location, as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various USA counties in function of different socioeconomic profiles and discuss the role of potential intermediary factors. METHODS The SEER database linked to county-level SES was utilized. Five-year PCa-specific survival using the Kaplan-Meier method was performed for five racial/ethnic categories in function of SES quintiles. Multilevel Cox proportional hazards regression was performed to assess the relationship between county-level SES and PCa survival. Multivariate regression analysis was performed to examine the role of healthcare utilization and severity. RESULTS A total of 239,613 PCa records were extracted, and 5-year PCa-specific survival was 94%. Overall, living in counties in the worst poverty/income quintile and the worst high-school level education increased PCa mortality by 38% and 33%, respectively, while the best bachelor's-level education rates decreased mortality risk by 23%. Associations varied considerably upon racial/ethnic stratification. Multilevel analyses showed varying contributions of individual and area-level factors to survival within minorities. The relationship between SES and PCa survival appeared to be influenced by healthcare utilization and disease stage/grade. DISCUSSION Racial/ethnic categories responded differently under similar county-level SES and individual-level factors to the point where disparities reversed in Hispanic populations. The inclusion of healthcare utilization and severity factors may provide partial early support for their role as intermediaries. Healthcare access (insurance) might not necessarily be associated with better PCa survival through the performance of biopsy and or/surgery. County-level education plays an important role in PCa decision making as it might elucidate discussions of other non-invasive management options. CONCLUSIONS The findings of this study demonstrate that interventions need to be tailored according to each group's needs. This potentially informs the focus of public health efforts in terms of planning and prioritization. This study could also direct further research delving into pathways between area-level characteristics with PCa survival.
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Affiliation(s)
- Christiane J. El Khoury
- Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY 11790, USA;
- Department of Medical Oncology, The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA 19123, USA
| | - Sean A. P. Clouston
- Program in Public Health, Renaissance School of Medicine at Stony Brook, Stony Brook, NY 11790, USA;
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook, Stony Brook, NY 11790, USA
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Hougen HY, Swami N, Dee EC, Alshalalfa M, Meiyappan K, Florez N, Penedo FJ, Nguyen PL, Punnen S, Mahal BA. Disparities in Diagnosis, Treatment Access, and Time to Treatment Among Hispanic Men With Metastatic Prostate Cancer. JCO Oncol Pract 2023; 19:645-653. [PMID: 37262399 PMCID: PMC10424902 DOI: 10.1200/op.23.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE Reporting racial/ethnic disparities in aggregate obscures within-group heterogeneity. We sought to identify disparities in diagnosis and treatment in Hispanic subpopulations with metastatic prostate cancer (mPCa). METHODS We disaggregated men with prostate adenocarcinoma from the National Cancer Database from 2004 to 2017 by racial subgroup and Hispanic background. We assessed (1) presenting with mPCa, (2) receiving any treatment, and (3) receiving delayed treatment beyond 90 days. Logistic regression and adjusted odds ratios (aOR) were reported. RESULTS Hispanic men had greater odds of presenting with mPCa (aOR, 1.54; 95% CI, 1.50 to 1.58; P < .001) compared with non-Hispanic White (NHW) men. All Hispanic racial subgroups were more likely to present with mPCa, with the highest risk in Hispanic Black (HB) men (aOR, 1.68; 95% CI, 1.46 to 1.93; P < .01). Men from all Hispanic backgrounds had higher odds of presenting with mPCa, especially Mexican men (aOR, 1.99; 95% CI, 1.86 to 2.12; P < .01). Hispanic men were less likely to receive any treatment (aOR, 0.60; 95% CI, 0.53 to 0.67; P < .001), and this effect was particularly strong for Hispanic White patients (aOR, 0.58; 95% CI, 0.52 to 0.66; P < .001) and Dominican men (aOR, 0.52; 95% CI, 0.28 to 0.98; P = .044). Hispanic men were more likely to experience treatment delays compared with NHW men (aOR, 1.38; 95% CI, 1.26 to 1.52; P < .001) and in particular HB (aOR, 1.83; 95% CI, 1.22 to 2.75; P = .002) and South/Central American men (aOR, 1.48; 95% CI, 1.07 to 2.04; P = .018). CONCLUSION Differences exist in stage at presentation, treatment receipt, and delays in treatment on disaggregation by racial subgroup and Hispanic heritage. We need to study the potential mechanisms of the observed variations to help develop targeted interventions.
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Affiliation(s)
- Helen Y. Hougen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | | | - Narjust Florez
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Frank J. Penedo
- Departments of Psychology and Medicine, University of Miami Miller School of Medicine and College of Arts and Sciences, Miami, FL
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Brandon A. Mahal
- Sylvester Comprehensive Cancer Center, Miami, FL
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL
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Chen C, Lin M, Yu D, Qin W, Zhou J, Guo L, Huang R, Fan X, Xiang S. Do disease status and race affect the efficacy of zoledronic acid in patients with prostate cancer? A systematic review and meta-analysis of randomized control trials. PLoS One 2022; 17:e0275176. [PMID: 36137135 PMCID: PMC9499269 DOI: 10.1371/journal.pone.0275176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 09/12/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Zoledronic acid (ZA) does not improve the overall survival (OS) of metastatic castration-resistant prostate cancer (mCRPC); however, little is known about the efficacy of ZA in to hormone-sensitive prostate cancer (HSPC), metastatic hormone-sensitive prostate cancer (mHSPC), and non- metastatic castration-resistant prostate cancer (nmCRPC). Therefore, we assessed the efficacy of ZA in patients with prostate cancer (PCa) and different disease statuses. METHODS Fifteen eligible randomized-control trials (RCTs) with ZA intervention, including 8280 participants with HSPC, mHSPC, nmCRPC, and mCRPC, were analyzed. The primary and secondary outcome were overall survival(OS), and skeletal-related events (SREs), and bone mineral density (BMD). RESULTS The participants included 8280 men (7856 non-Asian and 424 Asian). Seven trials yielded a pooled hazard ratio (HR) of 0.95 (0.88, 1.03; P = 0.19) for OS. Subgroup analysis revealed no significant improvement in OS in the HSPC, castration-resistant prostate cancer (CRPC), M0 and M1(bone metastasis) groups, with pooled HR (95%CI) of 0.96 (0.88,1.05), 0.78 (0.46,1.33), 0.95 (0.81,1.13), 0.85 (0.69,1.04) respectively. The Asian group exhibited improved in OS with an HR of 0.67 (0.48, 0.95; P = 0.02), whereas the non-Asian group showed no improvement in OS with an HR of 0.97 (0.90, 1.06; P = 0.52). Five trials yielded pooled odds ratio (OR) of 0.65 (0.45, 0.95; P = 0.02) for SREs. In the subgroup, SREs were significantly decreased in the M1 and Asian groups with ORs of 0.65 (0.45, 0.95; P = 0.02) and 0.42 (0.24, 0.71; P = 0.001), respectively. Six trials yielded a pooled mean difference (MD) of 8.08 (5.79, 10.37; P < 0.001) for BMD. In the HSPC we observed a stable improvement in increased BMD percentage with an MD (95%CI) of 6.65 (5.67, 7.62) (P = 0.001). CONCLUSIONS ZA intervention does not significantly improve OS in patients with prostate cancer (HSPC, CRPC, M0, M1) but probably improves OS in the Asian populations. M1 and Asian groups had exhibit a significant reduction in SREs regardless of the HSPC or CRPC status after ZA administration. Moreover, ZA treatment increases BMD percentage.
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Affiliation(s)
- Chiwei Chen
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mandi Lin
- Department of Radiotherapy, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Daocheng Yu
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weiting Qin
- Department of Urology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianfu Zhou
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lang Guo
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Renlun Huang
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xinxiang Fan
- Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Songtao Xiang
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Hougen HY, Iakymenko OA, Punnen S, Ritch CR, Nahar B, Parekh DJ, Kryvenko ON, Gonzalgo ML. Prostate cancer upgrading and adverse pathology in Hispanic men undergoing radical prostatectomy. World J Urol 2022; 40:2017-2023. [PMID: 35689106 DOI: 10.1007/s00345-022-04065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Radical prostatectomy (RP) outcomes in Hispanic men with prostate cancer are not well-described. Prior studies showed varying results regarding the rate of upgrading and upstaging, and these studies included limited pathologic data and lack of central pathology review. We characterized the rate of upgrading, adverse pathology, and oncologic outcomes in Hispanics after prostatectomy using a large institutional database. METHODS We included Hispanic white (HW), non-Hispanic white (NHW), and black men who underwent (RP) between 2010 and 2021 at a single institution. We recorded differences in grade group between biopsy and prostatectomy and performed multivariable analyses for odds of upgrading and adverse pathologic findings. The primary outcome was rate of upgrading in HWs. Using a sub-cohort with follow-up data, we assessed race/ethnicity and upgrading as a predictor of biochemical recurrence (BCR)-free survival. RESULTS Our cohort included 1877 men: 36.7% were NHW, 40.6% were HW, and 22.7% were black. Rates of upgrading were not different between NHW, NHW, and black men at 34.0, 33.8, and 37.3%, respectively (p = 0.4). In the multivariable analysis for upgrading, significant predictors for upgrading were older age (p = 0.002), higher PSA (p < 0.001), and lower prostate weight (p = 0.02), but race/ethnicity did not predict upgrading. In patients with available follow-up (1083, 58%), upgrading predicted worse BCR-free survival (HR 2.17, CI 1.46-3.22, p < 0.0001) but race/ethnicity did not. CONCLUSIONS HW men undergoing RP had similar rates of upgrading and adverse pathologic outcomes as NHW men. Race/ethnicity does not independently predict upgrading or worse oncologic outcomes after RP.
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Affiliation(s)
- Helen Y Hougen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.
| | - Oleksii A Iakymenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 15th Floor, Miami, FL, 33136, USA.,Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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7
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Prostate cancer risk in men of differing genetic ancestry and approaches to disease screening and management in these groups. Br J Cancer 2022; 126:1366-1373. [PMID: 34923574 PMCID: PMC9090767 DOI: 10.1038/s41416-021-01669-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/02/2021] [Accepted: 12/03/2021] [Indexed: 01/12/2023] Open
Abstract
Prostate cancer is the second most common solid tumour in men worldwide and it is also the most common cancer affecting men of African descent. Prostate cancer incidence and mortality vary across regions and populations. Some of this is explained by a large heritable component of this disease. It has been established that men of African and African Caribbean ethnicity are predisposed to prostate cancer (PrCa) that can have an earlier onset and a more aggressive course, thereby leading to poorer outcomes for patients in this group. Literature searches were carried out using the PubMed, EMBASE and Cochrane Library databases to identify studies associated with PrCa risk and its association with ancestry, screening and management of PrCa. In order to be included, studies were required to be published in English in full-text form. An attractive approach is to identify high-risk groups and develop a targeted screening programme for them as the benefits of population-wide screening in PrCa using prostate-specific antigen (PSA) testing in general population screening have shown evidence of benefit; however, the harms are considered to weigh heavier because screening using PSA testing can lead to over-diagnosis and over-treatment. The aim of targeted screening of higher-risk groups identified by genetic risk stratification is to reduce over-diagnosis and treat those who are most likely to benefit.
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8
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Oehrlein N, Streicher SA, Kuo HC, Chaurasia A, McFadden J, Nousome D, Chen Y, Stroup SP, Musser J, Brand T, Porter C, Rosner IL, Chesnut GT, Onofaro KC, Rebbeck TR, D'Amico A, Lu-Yao G, Cullen J. Race-specific prostate cancer outcomes in a cohort of military health care beneficiaries undergoing surgery: 1990-2017. Cancer Med 2022; 11:4354-4365. [PMID: 35638719 PMCID: PMC9678085 DOI: 10.1002/cam4.4787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/31/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background There is substantial variability in prostate cancer (PCa) mortality rates across Caucasian American (CA), African American (AA), Asian, and Hispanic men; however, these estimates are unable to disentangle race or ethnicity from confounding factors. The current study explores survival differences in long‐term PCa outcomes between self‐reported AA and CA men, and examines clinicopathologic features across self‐reported CA, AA, Asian, and Hispanic men. Methods This retrospective cohort study utilized the Center for Prostate Disease Research (CPDR) Multi‐center National Database from 1990 to 2017. Subjects were consented at military treatment facilities nationwide. AA, CA, Asian, or Hispanic men who underwent radical prostatectomy (RP) for localized PCa within the first year of diagnosis were included in the analyses. Time from RP to biochemical recurrence (BCR), BCR to metastasis, and metastasis to overall death were evaluated using Kaplan–Meier unadjusted estimation curves and adjusted Cox proportional hazards regression. Results This study included 7067 men, of whom 5155 (73%) were CA, 1468 (21%) were AA, 237 (3%) were Asian, and 207 (3%) were Hispanic. AA men had a significantly decreased time from RP to BCR compared to CA men (HR = 1.25, 95% CI = 1.06–1.48, p = 0.01); however, no difference was observed between AA and CA men for a time from BCR to metastasis (HR = 0.73, 95% CI = 0.39–1.33, p = 0.302) and time from metastasis to overall death (HR = 0.67, 95% CI = 0.36–1.26, p = 0.213). Conclusions In an equal access health care setting, AA men had a shorter survival time from RP to BCR, but comparable survival time from BCR to metastasis and metastasis to overall death.
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Affiliation(s)
- Nathan Oehrlein
- Urology Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Samantha A Streicher
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Huai-Ching Kuo
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Avinash Chaurasia
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Radiation Oncology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jacob McFadden
- Urology Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Darryl Nousome
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Yongmei Chen
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Sean P Stroup
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Urology, Naval Medical Center San Diego, San Diego, California, USA
| | - John Musser
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Timothy Brand
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Madigan Army Medical Center, Tacoma, WA, USA
| | - Christopher Porter
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Virginia Mason Medical Center, Seattle, WA, USA
| | - Inger L Rosner
- Urology Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Gregory T Chesnut
- Urology Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kayla C Onofaro
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Department of Urology, Naval Medical Center San Diego, San Diego, California, USA
| | | | - Anthony D'Amico
- Division of Population Sciences, Dana Farber Cancer Institute and Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Grace Lu-Yao
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.,Sidney Kimmel Cancer Center at Jefferson, Philadelphia, Pennsylvania, USA.,Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Jennifer Cullen
- Center for Prostate Disease Research, Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA.,Case Comprehensive Cancer Center, Cleveland, Ohio, USA
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9
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Roebuck E, Sha W, Lu C, Miller C, Burgess E, Grigg C, Zhu J, Gaston KE, Riggs S, Matulay JT, Clark PE, Kearns J. Racial and Socioeconomic Disparities in MRI-Fusion Biopsy Utilization to Assess for Prostate Cancer. Urology 2022; 163:156-163. [PMID: 34995563 DOI: 10.1016/j.urology.2021.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate whether racial disparities in MRI-Bx usage persisted after correction for socioeconomic, demographic, and clinical factors. METHODS This is a retrospective cohort study of patients who received either MRI-Bx or systematic biopsy (SB) within a single academic medical center between January 2018 - June 2020. For each patient, socioeconomic variables including household income, education, percent below poverty, and unemployment were estimated using 2015 American Community Survey census-tract level data. Chi-square analysis was used to examine differences in clinical and demographic characteristics between the two groups. The Benjamini-Hochberg procedure was used to control false discovery rate (FDR) for multiple testing. RESULTS Eighteen percent of Black men (53/295) received MRI-Bx while 41% (228/561) of white men received MRI-Bx. Patients coming from highly impoverished areas were less likely to receive MRI-Bx, 25% versus 75%, respectively. In multivariate analysis, race remained significantly different across MRI-Bx and SB groups. Clinical factors including family history, DRE, BMI, and prostate volume were not significantly different between patients receiving MRI-Bx and SB. CONCLUSIONS Black men are less likely to receive MRI-Bx than white men, even after adjusting for clinical and socioeconomic characteristics. Further work is necessary to identify and study methods to increase equity in PCa diagnostic testing.
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Affiliation(s)
- Emily Roebuck
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Wei Sha
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Caroline Lu
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Caroline Miller
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Earle Burgess
- Department of Medical Oncology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Claud Grigg
- Department of Medical Oncology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Jason Zhu
- Department of Medical Oncology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Kris E Gaston
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Stephen Riggs
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Justin T Matulay
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Peter E Clark
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - James Kearns
- Department of Urology, Levine Cancer Institute/Atrium Health, Charlotte, NC.
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10
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Overall survival of black and white men with metastatic castration-resistant prostate cancer (mCRPC): a 20-year retrospective analysis in the largest healthcare trust in England. Prostate Cancer Prostatic Dis 2021; 24:718-724. [PMID: 33479454 DOI: 10.1038/s41391-020-00316-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prostate cancer in black men is associated with poorer outcomes than their white counterparts. However, most studies reporting this disparity were conducted in localized prostate cancer and primarily in the United States. METHODS Data regarding prostate cancer incidence and mortality for East London between 2008 and 2010 were obtained from the UK National Disease Registration Service. We further evaluated survival outcomes of 425 cases of mCRPC in St Bartholomew's Hospital, East London, between 1997 and 2016, and analyzed whether ethnicity impacted on responses to different treatment types. RESULTS The incidence of prostate cancer in black men was higher than white men in East London. Prostate cancer-specific mortality was proportional to incidence based on ethnic groups. In the detailed analysis of 425 patients, 103 patients (24%) were black (B), and the remainder white (W). Baseline characteristics were comparable in both groups, although black patients had a lower baseline hemoglobin (p < 0.001). Median overall survival for the total cohort was 25.5 months (B) vs 21.8 months (W) (hazard ratio (HR) = 0.81, p = 0.08). There was prolonged survival in the black population in those who only received hormone-based treatment throughout their treatment course; 39.7 months (B) vs 17.1 months (W) (HR = 0.54, p = 0.019). CONCLUSION Black men may do better than white men with mCRPC, in the context of equal access to healthcare. The study also suggests a greater margin of benefit of hormone-based therapy in the black subpopulation.
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11
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DeRouen MC, Yang J, Jain J, Weden MM, Gomez SL, Shariff-Marco S. Disparities in Prostate Cancer Survival According to Neighborhood Archetypes, A Population-Based Study. Urology 2021; 163:138-147. [PMID: 34303761 DOI: 10.1016/j.urology.2021.05.085] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine survival among men with prostate cancer according to neighborhood archetypes. As an advancement beyond measures of neighborhood socioeconomic status (nSES) or specific measures of the neighborhood environment, archetypes consider interactions among many social and built environment attributes. METHODS Neighborhood archetypes for California census tracts in the year 2000 were previously developed through latent class analysis of 39 measures of social and built environment attributes. We assessed associations between archetypes and overall and prostate cancer-specific survival in this population-based study using geocoded cancer registry data for prostate cancer patients diagnosed 1996-2005 in California, followed through 2017 (n = 185,613). We used Cox proportional hazard models stratified by race/ethnicity and adjusted for age at diagnosis, year of diagnosis, tumor factors, treatment, marital status and cluster effect by census tract. Additional analyses examined associations between race/ethnicity and survival, while accounting for neighborhood archetypes. RESULTS We observed disparities in overall and prostate cancer-specific risk of death by neighborhood archetypes. Classes with the highest risk of death were defined by lower nSES, but also other domains such as rural/urban status, racial/ethnic composition or age of residents, commuting and traffic patterns, residential mobility, and food environment. Associations between archetypes and survival varied by race/ethnicity. CONCLUSION We observe interactions among several domains of neighborhood social and built environment attributes as demonstrated by the associations between neighborhood archetypes and prostate cancer survival. These results highlight opportunities for multilevel neighborhood interventions to reduce neighborhood disparities in prostate cancer survival.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Juan Yang
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California
| | - Jennifer Jain
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California
| | | | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California
| | - Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, California; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California; Greater Bay Area Cancer Registry, San Francisco, California.
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12
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Wilkins LJ, Tosoian JJ, Reichard CA, Sundi D, Ranasinghe W, Alam R, Schwen Z, Reddy C, Allaf M, Davis JW, Chapin BF, Ross AE, Klein EA, Nyame YA. Oncologic outcomes among Black and White men with grade group 4 or 5 (Gleason score 8-10) prostate cancer treated primarily by radical prostatectomy. Cancer 2021; 127:1425-1431. [PMID: 33721334 DOI: 10.1002/cncr.33419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim of this study was to describe pathologic and short-term oncologic outcomes among Black and White men with grade group 4 or 5 prostate cancer managed primarily by radical prostatectomy. METHODS This was a multi-institutional, observational study (2005-2015) evaluating radical prostatectomy outcomes by self-identified race. Descriptive analysis was performed via nonparametric statistical testing to compare baseline clinicopathologic data. Univariable and multivariable time-to-event analyses were performed to assess biochemical recurrence (BCR), metastasis, cancer-specific mortality (CSM), and overall survival between Black and White men. RESULTS In total, 1662 men were identified with grade group 4 or 5 prostate cancer initially managed by radical prostatectomy. Black men represented 11.3% of the cohort (n = 188). Black men were younger, demonstrated a longer time from diagnosis to surgery, and were at a lower clinical stage (all P < .05). Black men had lower rates of pT3/4 disease (49.5% vs 63.5%; P < .05) but higher rates of positive surgical margins (31.6% vs 26.5%; P = .14) on pathologic evaluation. There was no difference in BCR, CSM, or overall survival over a median follow-up of 40.7 months. Black men had a lower 5-year cumulative incidence of metastasis-free survival (93.6%; 95% confidence interval [CI], 86.5%-97.0%) in comparison with White men (85.8%; 95% CI, 83.1%-88.0%), which did not persist in an age-adjusted analysis. CONCLUSIONS Black and White men with high-grade prostate cancer at diagnosis demonstrated similar oncologic outcomes when they were managed by primary radical prostatectomy. Our findings suggest that racial disparities in prostate cancer mortality are not related to differences in the efficacy of extirpative therapy.
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Affiliation(s)
- Lamont J Wilkins
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | | | - Chad A Reichard
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Urology of Indiana, Indianapolis, Indiana
| | - Debasish Sundi
- Department of Urology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Weranja Ranasinghe
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ridwan Alam
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Zeyad Schwen
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Chandana Reddy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammed Allaf
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashley E Ross
- Department of Urology, Northwestern University, Chicago, Illinois
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, Washington
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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13
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Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR, Davis M, de Smith AJ, Dutil J, Figueiredo JC, Fox R, Graves KD, Gomez SL, Llera A, Neuhausen SL, Newman L, Nguyen T, Palmer JR, Palmer NR, Pérez-Stable EJ, Piawah S, Rodriquez EJ, Sanabria-Salas MC, Schmit SL, Serrano-Gomez SJ, Stern MC, Weitzel J, Yang JJ, Zabaleta J, Ziv E, Fejerman L. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021; 124:315-332. [PMID: 32901135 PMCID: PMC7852513 DOI: 10.1038/s41416-020-01038-6] [Citation(s) in RCA: 481] [Impact Index Per Article: 160.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA-African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.
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Affiliation(s)
- Valentina A Zavala
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - John M Carethers
- Departments of Internal Medicine and Human Genetics, and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Luis Carvajal-Carmona
- University of California Davis Comprehensive Cancer Center and Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
- Genome Center, University of California Davis, Davis, CA, USA
| | | | - Marcia R Cruz-Correa
- Department of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Melissa Davis
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rena Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Andrea Llera
- Laboratorio de Terapia Molecular y Celular, IIBBA, Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Lisa Newman
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
- Interdisciplinary Breast Program, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Tung Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sorbarikor Piawah
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Silvia J Serrano-Gomez
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Mariana C Stern
- Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey Weitzel
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jovanny Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, New Orleans, LA, USA
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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14
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Slezak JM, Van Den Eeden SK, Cannavale KL, Chien GW, Jacobsen SJ, Chao CR. Long-term follow-up of a racially and ethnically diverse population of men with localized prostate cancer who did not undergo initial active treatment. Cancer Med 2020; 9:8530-8539. [PMID: 32965775 PMCID: PMC7666755 DOI: 10.1002/cam4.3471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/23/2020] [Accepted: 08/23/2020] [Indexed: 11/28/2022] Open
Abstract
Background There is limited research on the racial/ethnic differences in long‐term outcomes for men with untreated, localized prostate cancer. Methods Men diagnosed with localized, Gleason ≤7 prostate cancer who were not treated within 1 year of diagnosis from 1997–2007 were identified. Cumulative incidence rates of the following events were calculated; treatment initiation, metastasis, death due to prostate cancer and all‐cause mortality, accounting for competing risks. The Cox model of all‐cause mortality and Fine‐Gray sub distribution model to account for competing risks were used to test for racial/ethnic differences in outcomes adjusted for clinical factors. Results There were 3925 men in the study, 749 Hispanic, 2415 non‐Hispanic white, 559 non‐Hispanic African American, and 202 non‐Hispanic Asian/Pacific Islander (API). Median follow‐up was 9.3 years. At 19 years, overall cumulative incidence of treatment, metastasis, death due to prostate cancer, and all‐cause mortality was 25.0%, 14.7%, 11.7%, and 67.8%, respectively. In adjusted models compared to non‐Hispanic whites, African Americans had higher rates of treatment (HR = 1.39, 95% CI = 1.15–1.68); they had an increased risk of metastasis beyond 10 years after diagnosis (HR = 4.70, 95% CI = 2.30–9.61); API and Hispanic had lower rates of all‐cause mortality (HR = 0.66, 95% CI = 0.52–0.84, and HR = 0.72, 95% CI = 0.62–0.85, respectively), and API had lower rates of prostate cancer mortality in the first 10 years after diagnosis (HR = 0.29, 95% CI = 0.09–0.90) and elevated risks beyond 10 years (HR = 5.41, 95% CI = 1.39–21.11). Conclusions Significant risks of metastasis and prostate cancer mortality exist in untreated men beyond 10 years after diagnosis, but are not equally distributed among racial/ethnic groups.
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Affiliation(s)
- Jeff M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gary W Chien
- Department of Urology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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15
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De la Garza Ramos R, Benton JA, Gelfand Y, Echt M, Flores Rodriguez JV, Yanamadala V, Yassari R. Racial disparities in clinical presentation, type of intervention, and in-hospital outcomes of patients with metastatic spine disease: An analysis of 145,809 admissions in the United States. Cancer Epidemiol 2020; 68:101792. [PMID: 32781406 DOI: 10.1016/j.canep.2020.101792] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/10/2020] [Accepted: 07/26/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Race is an important determinant of cancer outcome. The purpose of this study was to identify disparities in clinical presentation, treatment use, and in-hospital outcomes of patients with spinal metastases. METHODS The United States National Inpatient Sample database (2004-2014) was queried to identify patients with metastatic disease and cord compression (MSCC) or spinal pathological fracture. Clinical presentation, type of intervention, and in-hospital outcomes were compared between races/ethnicities. Multivariate logistic regression analyses were performed and adjusted for differences in patient age, sex, insurance status, income quartile, hospital teaching status and size, Charlson comorbidity index, smoking status, tumor type, and neurological status. RESULTS A total of 145,809 patients were identified - 74.8 % Caucasian, 14.1 % African-American, 7.9 % Hispanic, and 3.2 % Asian. Over one-third of patients (38.1 %) presented with MSCC; 35.7 % of Caucasians, 50.3 % of AAs, 41.1 % of Hispanics, and 39.8 % of Asians (p < 0.001). Paralysis affected 8.4 % of all patients; 7.4 % of Caucasians, 12.7 % of AAs, 10.5 % of Hispanics, and 10.0 % of Asians (p < 0.001). For patients with MSCC, multivariate analysis showed that AAs were less likely to undergo surgical intervention (OR 0.71; 95 % CI, 0.62 - 0.82; p < 0.001), significantly more likely to experience a complication (OR 1.25; 95 % CI, 1.12-1.40; p < 0.001), significantly more likely to experience prolonged length of stay (OR 1.22; 95 % CI, 1.08-1.36; p = 0.001), and significantly more likely to experience a non-routine discharge (OR 1.19; 95 % CI, 1.05-1.35; p = 0.007) compared to Caucasians. CONCLUSION Minority groups with spinal metastatic disease may be at a disadvantage compared to Caucasians, with significant disparities found in presenting characteristics, type of intervention, and in-hospital outcomes. Continued efforts to overcome these differences are needed.
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Affiliation(s)
- Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Joshua A Benton
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
| | - Murray Echt
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
| | - Jessica V Flores Rodriguez
- Immigrant Health and Cancer Disparities, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Vijay Yanamadala
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, United States
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16
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PSA, stage, grade and prostate cancer specific mortality in Asian American patients relative to Caucasians according to the United States Census Bureau race definitions. World J Urol 2020; 39:787-796. [PMID: 32458094 PMCID: PMC7969699 DOI: 10.1007/s00345-020-03242-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/05/2020] [Indexed: 12/05/2022] Open
Abstract
Background The United States Census Bureau recommends distinguishing between “Asians” vs. “Native Hawaiians or Other Pacific Islanders” (NHOPI). We tested for prognostic differences according to this stratification in patients with prostate cancer (PCa) of all stages. Methods Descriptive statistics, time-trend analyses, Kaplan–Meier plots and multivariate Cox regression models were used to test for differences at diagnosis, as well as for cancer specific mortality (CSM) according to the Census Bureau’s definition in either non-metastatic or metastatic patients vs. 1:4 propensity score (PS)-matched Caucasian controls, identified within the Surveillance, Epidemiology and End Results database (2004–2016). Results Of all 380,705 PCa patients, NHOPI accounted for 1877 (0.5%) vs. 23,343 (6.1%) remaining Asians vs. 93.4% Caucasians. NHOPI invariably harbored worse PCa characteristics at diagnosis. The rates of PSA ≥ 20 ng/ml, Gleason ≥ 8, T3/T4, N1- and M1 stages were highest for NHOPI, followed by Asians, followed by Caucasians (PSA ≥ 20: 18.4 vs. 14.8 vs. 10.2%, Gleason ≥ 8: 24.9 vs. 22.1, vs. 15.9%, T3/T4: 5.5 vs. 4.2 vs. 3.5%, N1: 4.4 vs. 2.8, vs. 2.7%, M1: 8.3 vs. 4.9 vs. 3.9%). Despite the worst PCa characteristics at diagnosis, NHOPI did not exhibit worse CSM than Caucasians. Moreover, despite worse PCa characteristics, Asians exhibited more favorable CSM than Caucasians in comparisons that focussed on non-metastatic and on metastatic patients. Conclusions Our observations corroborate the validity of the distinction between NHOPI and Asian patients according to the Census Bureau’s recommendation, since these two groups show differences in PSA, grade and stage characteristics at diagnosis in addition to exhibiting differences in CSM even after PS matching and multivariate adjustment.
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Olender J, Lee NH. Role of Alternative Splicing in Prostate Cancer Aggressiveness and Drug Resistance in African Americans. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1164:119-139. [PMID: 31576545 PMCID: PMC6777849 DOI: 10.1007/978-3-030-22254-3_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alternative splicing, the process of removing introns and joining exons of pre-mRNA, is critical for growth, development, tissue homeostasis, and species diversity. Dysregulation of alternative splicing can initiate and drive disease. Aberrant alternative splicing has been shown to promote the "hallmarks of cancer" in both hematological and solid cancers. Of interest, recent work has focused on the role of alternative splicing in prostate cancer and prostate cancer health disparities. We will provide a review of prostate cancer health disparities involving the African American population, alternative RNA splicing, and alternative splicing in prostate cancer. Lastly, we will summarize our work on differential alternative splicing in prostate cancer disparities and its implications for disparate health outcomes and therapeutic targets.
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Affiliation(s)
- Jacqueline Olender
- Department of Pharmacology and Physiology, GW Cancer Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Norman H Lee
- Department of Pharmacology and Physiology, GW Cancer Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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18
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Halabi S, Dutta S, Tangen CM, Rosenthal M, Petrylak DP, Thompson IM, Chi KN, Araujo JC, Logothetis C, Quinn DI, Fizazi K, Morris MJ, Eisenberger MA, George DJ, De Bono JS, Higano CS, Tannock IF, Small EJ, Kelly WK. Overall Survival of Black and White Men With Metastatic Castration-Resistant Prostate Cancer Treated With Docetaxel. J Clin Oncol 2018; 37:403-410. [PMID: 30576268 DOI: 10.1200/jco.18.01279] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Several studies have reported that among patients with localized prostate cancer, black men have a shorter overall survival (OS) time than white men, but few data exist for men with advanced prostate cancer. The primary goal of this analysis was to compare the OS in black and white men with metastatic castration-resistant prostate cancer (mCRPC) who were treated in phase III clinical trials with docetaxel plus prednisone (DP) or a DP-containing regimen. METHODS Individual participant data from 8,820 men with mCRPC randomly assigned in nine phase III trials to DP or a DP-containing regimen were combined. Race was based on self-report. The primary end point was OS. The Cox proportional hazards regression model was used to assess the prognostic importance of race (black v white) adjusted for established risk factors common across the trials (age, prostate-specific antigen, performance status, alkaline phosphatase, hemoglobin, and sites of metastases). RESULTS Of 8,820 men, 7,528 (85%) were white, 500 (6%) were black, 424 (5%) were Asian, and 368 (4%) were of unknown race. Black men were younger and had worse performance status, higher testosterone and prostate-specific antigen, and lower hemoglobin than white men. Despite these differences, the median OS was 21.0 months (95% CI, 19.4 to 22.5 months) versus 21.2 months (95% CI, 20.8 to 21.7 months) in black and white men, respectively. The pooled multivariable hazard ratio of 0.81 (95% CI, 0.72 to 0.91) demonstrates that overall, black men have a statistically significant decreased risk of death compared with white men ( P < .001). CONCLUSION When adjusted for known prognostic factors, we observed a statistically significant increased OS in black versus white men with mCRPC who were enrolled in these clinical trials. The mechanism for these differences is not known.
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Affiliation(s)
| | | | | | - Mark Rosenthal
- 3 The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | | | - Kim N Chi
- 6 BC Cancer Agency Vancouver Centre, Vancouver, BC
| | - John C Araujo
- 7 The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - David I Quinn
- 8 University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Mario A Eisenberger
- 11 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | - Johann S De Bono
- 12 The Institute of Cancer Research and The Royal Marsden National Health Service Foundation Trust, Sutton, United Kingdom
| | | | - Ian F Tannock
- 13 Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric J Small
- 14 University of California San Francisco, San Francisco, CA
| | - William Kevin Kelly
- 15 Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
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19
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Racial and Ethnic Trends in Prostate Cancer Incidence and Mortality in Philadelphia, PA: an Observational Study. J Racial Ethn Health Disparities 2018; 6:371-379. [PMID: 30520002 DOI: 10.1007/s40615-018-00534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND To learn more about local prostate cancer (PCa) disparities, we conducted descriptive analyses of the role of race and age in PCa using the Pennsylvania Cancer Registry data for Philadelphia (2005-2014). METHODS We focused on the most prevalent race/ethnic groups: white (33%), black (44%), and Hispanic (9%). Outcomes included PCa rates, tumor stage, and tumor grade. Percent change was used to describe changes in age-adjusted incidence and mortality rates. Frequency tables and logistic regression models were used to describe trends in proportions of advanced PCa by race and time. Race-by-time interaction terms were retained in the models if statistically significant. RESULTS PCa incidence was highest for black men over time. Incidence rates declined over time for all race groups (- 28% for white men to - 38% for Hispanic men). PCa mortality rates declined in a less universal manner (- 5% for blacks to - 32% for whites). Each year, odds increased across all race groups for advanced tumor stage (4% each year among white and Hispanic men and 9% each year among black men) and for advanced tumor grade (4% each year among white and black men and 23% each year among Hispanic men). Among younger men, black men experienced significantly increased odds of advanced tumor stage each year (8%) and Hispanics experienced significantly increased odds of advanced tumor grade each year (30%). CONCLUSIONS Black men remain at highest PCa risk relative to other racial/ethnic groups in Philadelphia. Younger black and Hispanic men are at particular risk for advanced PCa at diagnosis.
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20
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Aminsharifi A, Polascik TJ, Tsivian M, Schulman A, Tsivian E, Tay KJ, Elshafei A, Jones JS. Does Any Racial Disparity Exist in Oncologic Outcomes After Primary Cryotherapy for Prostate Cancer? A Matched-pair Comparative Analysis of the Cryo On-Line Data Registry. Clin Genitourin Cancer 2018; 16:e1073-e1076. [PMID: 30054221 DOI: 10.1016/j.clgc.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/03/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND African-American (AA) men have the greatest incidence of and disease-specific mortality from prostate cancer of any racial group. Although encouraging oncologic and functional outcomes have been reported with prostate cancer cryotherapy, little is known about how ethnicity can potentially affect the oncologic outcomes of primary cryotherapy. We report the oncologic outcomes of primary cryotherapy in AA patients through a matched-pair analysis. PATIENTS AND METHODS A 1:2 (AA to non-AA) cohort of patients was designed using the Cryo-On-Line Data Registry. The 2 arms were matched for patient age, prostate-specific antigen level, Gleason score, and prostate volume. The oncologic outcome was defined in terms of the biochemical recurrence (BCR) rates after primary cryoablation using Phoenix criteria. The results of "for-cause" post-treatment biopsies and the BCR-free survival rates were also analyzed between the 2 groups. RESULTS The 1:2 cohort of AA and non-AA men in the present study included 109 and 218 men, respectively. Their median age (69 vs. 71 years; P = .71), median prostate-specific antigen level (6.5 vs. 6.8 ng/mL; P = .95), median prostate volume (32 vs. 30 cm3; P = .31), Gleason score distribution (P = .97), and prostate cancer risk group (P = .12) were similar statistically. The median postoperative follow-up period was also comparable between the 2 groups (AA, 32 months vs. non-AA, 27 months; P = .52). The BCR rates were similar between the AA and non-AA men (14% vs. 17%; P = .52). Likewise, the rate of positive "for-cause" prostate biopsy findings was similar between the 2 groups (AA vs. non-AA, 25% vs. 36%; P = .44). Furthermore, the 5-year biochemical relapse-free survival rates were comparable for the AA and non-AA patients (74% vs. 71%; P = .37). CONCLUSION When matched for tumor characteristics, cryotherapy as a treatment modality for primary, clinically localized prostate cancer offers men of African-American descent similar oncologic outcomes to those of non-AA men.
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Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Duke Cancer Institute, Durham, NC; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | - Efrat Tsivian
- Division of Urology, Duke Cancer Institute, Durham, NC
| | - Kae Jack Tay
- Division of Urology, Duke Cancer Institute, Durham, NC; SingHealth, Singapore General Hospital, Singapore
| | - Ahmed Elshafei
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of Urology, Medical School, Cairo University, Cairo, Egypt
| | - J Stephen Jones
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH
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21
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Williams VL, Awasthi S, Fink AK, Pow‐Sang JM, Park JY, Gerke T, Yamoah K. African-American men and prostate cancer-specific mortality: a competing risk analysis of a large institutional cohort, 1989-2015. Cancer Med 2018; 7:2160-2171. [PMID: 29601662 PMCID: PMC5943433 DOI: 10.1002/cam4.1451] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 11/12/2022] Open
Abstract
Significant racial disparities in prostate cancer (PCa) outcomes have been reported, with African-American men (AAM) more likely to endure adverse oncologic outcomes. Despite efforts to dissipate racial disparities in PCa, a survival gap persists and it remains unclear to what extent this disparity can be explained by known clinicodemographic factors. In this study, we leveraged our large institutional database, spanning over 25 years, to investigate whether AAM continued to experience poor PCa outcomes and factors that may contribute to racial disparities in PCa. A total of 7307 patients diagnosed with PCa from 1989 through 2015 were included. Associations of race and clinicodemographic characteristics were analyzed using chi-square for categorical and Mann-Whitney U-test for continuous variables. Racial differences in prostate cancer outcomes were analyzed using competing risk analysis methods of Fine and Gray. Median follow-up time was 106 months. There were 2304 deaths recorded, of which 432 resulted from PCa. AAM were more likely to be diagnosed at an earlier age (median 60 vs. 65 years, P = <0.001) and were more likely to have ≥1 comorbidities (13.6% vs. 7.5%, P < 0.001). In a multivariate competing risk model, adjusted for baseline covariates, AAM experienced significantly higher risk of PCSM compared to NHW men (HR, 1.62, 95% CI, 1.02-2.57, P = 0.03) NHW. Among men diagnosed at an older age (>60 years), racial differences in PCSM were more pronounced, with AAM experiencing higher rates of PCSM (HR, 2.05, 95% CI, 1.26-3.34, P = 0.003). After adjustment of clinicodemographic and potential risk factors, AAM continue to experience an increased risk of mortality from PCa, especially older AAM. Furthermore, AAM are more likely to be diagnosed at an early age and more likely to have higher comorbidity indices.
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Affiliation(s)
| | - Shivanshu Awasthi
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Angelina K. Fink
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Julio M. Pow‐Sang
- Department of Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Jong Y. Park
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Travis Gerke
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
| | - Kosj Yamoah
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
- Department of Radiation OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFlorida
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22
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DeRouen MC, Schupp CW, Koo J, Yang J, Hertz A, Shariff-Marco S, Cockburn M, Nelson DO, Ingles SA, John EM, Gomez SL. Impact of individual and neighborhood factors on disparities in prostate cancer survival. Cancer Epidemiol 2018; 53:1-11. [PMID: 29328959 PMCID: PMC7499899 DOI: 10.1016/j.canep.2018.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND We addressed the hypothesis that individual-level factors act jointly with social and built environment factors to influence overall survival for men with prostate cancer and contribute to racial/ethnic and socioeconomic (SES) survival disparities. METHODS We analyzed multi-level data, combining (1) individual-level data from the California Collaborative Prostate Cancer Study, a population-based study of non-Hispanic White (NHW), Hispanic, and African American prostate cancer cases (N = 1800) diagnosed from 1997 to 2003, with (2) data on neighborhood SES (nSES) and social and built environment factors from the California Neighborhoods Data System, and (3) data on tumor characteristics, treatment and follow-up through 2009 from the California Cancer Registry. Multivariable, stage-stratified Cox proportional hazards regression models with cluster adjustments were used to assess education and nSES main and joint effects on overall survival, before and after adjustment for social and built environment factors. RESULTS African American men had worse survival than NHW men, which was attenuated by nSES. Increased risk of death was associated with residence in lower SES neighborhoods (quintile 1 (lowest nSES) vs. 5: HR = 1.56, 95% CI: 1.11-2.19) and lower education ( CONCLUSION Both individual- and contextual-level SES influence overall survival of men with prostate cancer. Additional research is needed to identify the mechanisms underlying these robust associations.
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Affiliation(s)
- Mindy C DeRouen
- Cancer Prevention Institute of California, Fremont, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Juan Yang
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Andrew Hertz
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Research Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA
| | - Myles Cockburn
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - David O Nelson
- Cancer Prevention Institute of California, Fremont, CA, USA; Department of Health Research Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA
| | - Sue A Ingles
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Esther M John
- Cancer Prevention Institute of California, Fremont, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Health Research Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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23
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Akinyemiju T, Sakhuja S, Waterbor J, Pisu M, Altekruse SF. Racial/ethnic disparities in de novo metastases sites and survival outcomes for patients with primary breast, colorectal, and prostate cancer. Cancer Med 2018; 7:1183-1193. [PMID: 29479835 PMCID: PMC5911612 DOI: 10.1002/cam4.1322] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 01/02/2023] Open
Abstract
Racial disparities in cancer mortality still exist despite improvements in treatment strategies leading to improved survival for many cancer types. In this study, we described race/ethnic differences in patterns of de novo metastasis and evaluated the association between site of de novo metastasis and breast, prostate, and colorectal cancer mortality. Data were obtained from the Surveillance Epidemiology and Ends Results (SEER) database from 2010 to 2013 and included 520,147 patients ages ≥40 years with primary diagnosis of breast, colorectal, or prostate cancer. Site and frequency of de novo metastases to four sites (bone, brain, liver, and lung) were compared by race/ethnicity using descriptive statistics, and survival differences examined using extended Cox regression models in SAS 9.4. Overall, non‐Hispanic (NH) Blacks (11%) were more likely to present with de novo metastasis compared with NH‐Whites (9%) or Hispanics (10%). Among patients with breast cancer, NH‐Blacks were more likely to have metastasis to the bone, (OR: 1.25, 95% CI: 1.15–1.37), brain (OR: 2.26, 95% CI: 1.57–3.25), or liver (OR: 1.62, 95% CI: 1.35–1.93), while Hispanics were less likely to have metastasis to the liver (OR: 0.76, 95% CI: 0.60–0.97) compared with NH‐Whites. Among patients with prostate cancer, NH‐Blacks (1.39, 95% CI: 1.31–1.48) and Hispanics (1.39, 95% CI: 1.29–1.49) were more likely to have metastasis to the bone. Metastasis to any of the four sites evaluated increased overall mortality by threefold (for breast cancer and metastasis to bone) to 17‐fold (for prostate cancer and metastasis to liver). Racial disparities in mortality remained after adjusting for metastasis site in all cancer types evaluated. De novo metastasis is a major contributor to cancer mortality in USA with racial differences in the site, frequency, and associated survival.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - John Waterbor
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria Pisu
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sean F Altekruse
- Cancer Statistics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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24
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Kumar S, Singh R, Malik S, Manne U, Mishra M. Prostate cancer health disparities: An immuno-biological perspective. Cancer Lett 2018; 414:153-165. [PMID: 29154974 PMCID: PMC5743619 DOI: 10.1016/j.canlet.2017.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 02/07/2023]
Abstract
Prostate cancer (PCa) is the most commonly diagnosed malignancy in males, and, in the United States, is the second leading cause of cancer-related death for men older than 40 years. There is a higher incidence of PCa for African Americans (AAs) than for European-Americans (EAs). Investigations related to the incidence of PCa-related health disparities for AAs suggest that there are differences in the genetic makeup of these populations. Other differences are environmentally induced (e.g., diet and lifestyle), and the exposures are different. Men who immigrate from Eastern to Western countries have a higher risk of PCa than men in their native countries. However, the number of immigrants developing PCa is still lower than that of men in Western countries, suggesting that genetic factors are involved in the development of PCa. Altered genetic polymorphisms are associated with PCa progression. Androgens and the androgen receptor (AR) are involved in the development and progression of PCa. For populations with diverse racial/ethnic backgrounds, differences in lifestyle, diet, and biology, including genetic mutations/polymorphisms and levels of androgens and AR, are risk factors for PCa. Here, we provide an immuno-biological perspective on PCa in relation to racial/ethnic disparities and identify factors associated with the disproportionate incidence of PCa and its clinical outcomes.
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Affiliation(s)
- Sanjay Kumar
- Cancer Biology Research and Training Program, Department of Biological Sciences, Alabama State University, Montgomery, AL 36104, USA
| | - Rajesh Singh
- Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Shalie Malik
- Cancer Biology Research and Training Program, Department of Biological Sciences, Alabama State University, Montgomery, AL 36104, USA; Department of Zoology, University of Lucknow, Lucknow 226007, India
| | - Upender Manne
- Department of Pathology, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Manoj Mishra
- Cancer Biology Research and Training Program, Department of Biological Sciences, Alabama State University, Montgomery, AL 36104, USA.
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25
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McClelland S, Perez CA. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States-part 3: Hispanic-American patients. Adv Radiat Oncol 2017; 3:93-99. [PMID: 29904731 PMCID: PMC6000066 DOI: 10.1016/j.adro.2017.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose Health disparities have profoundly affected underrepresented minorities throughout the United States, particularly with regard to access to evidence-based interventions such as surgery or medication. The degree of disparity in access to radiation therapy (RT) for Hispanic-American patients with cancer has not been previously examined in an extensive manner. Methods and materials An extensive literature search was performed using the PubMed database to examine studies investigating disparities in RT access for Hispanic-Americans. Results A total of 34 studies were found, spanning 10 organ systems. Disparities in access to RT for Hispanic-Americans were most prominently studied in cancers of the breast (15 studies), prostate (4 studies), head and neck (4 studies), and gynecologic system (3 studies). Disparities in RT access for Hispanic-Americans were prevalent regardless of the organ system studied and were compounded by limited English proficiency and/or birth outside of the United States. A total of 26 of 34 studies (77%) involved analysis of a population-based database, such as Surveillance, Epidemiology and End Result (15 studies); Surveillance, Epidemiology and End Result-Medicare (4 studies); National Cancer Database (3 studies); or a state tumor registry (4 studies). Conclusions Hispanic-Americans in the United States have diminished RT access compared with Caucasian patients but are less likely to experience concomitant disparities in mortality than other underrepresented minorities that experience similar disparities (ie, African-Americans). Hispanic-Americans who are born outside of the United States and/or have limited English proficiency may be more likely to experience substandard RT access. These results underscore the importance of finding nationwide solutions to address such inequalities that hinder Hispanic-Americans and other underrepresented minorities throughout the United States.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Carmen A Perez
- Department of Radiation Oncology, New York University, New York, New York
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26
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Smith CJ, Minas TZ, Ambs S. Analysis of Tumor Biology to Advance Cancer Health Disparity Research. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 188:304-316. [PMID: 29137948 DOI: 10.1016/j.ajpath.2017.06.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/24/2017] [Accepted: 06/29/2017] [Indexed: 12/20/2022]
Abstract
Cancer mortality rates in the United States continue to decline. Reductions in tobacco use, uptake of preventive measures, adoption of early detection methods, and better treatments have resulted in improved cancer outcomes for men and women. Despite this progress, some population groups continue to experience an excessive cancer burden when compared with other population groups. One of the most prominent cancer health disparities exists in prostate cancer. Prostate cancer mortality rates are highest among men of African ancestry when compared with other men, both in the United States and globally. This disparity and other cancer health disparities are largely explained by differences in access to health care, diet, lifestyle, cultural barriers, and disparate exposures to carcinogens and pathogens. Dietary and lifestyle factors, pathogens, and ancestry-related factors can modify tumor biology and induce a more aggressive disease. There are numerous examples of how environmental exposures, like tobacco, chronic stress, or dietary factors, induce an adverse tumor biology, leading to a more aggressive disease and decreased patient survival. Because of population differences in the exposure to these risk factors, they can be the cause of cancer disparities. In this review, we will summarize recent advances in our understanding of prostate and breast cancer disparities in the United States and discuss how the analysis of tumor biology can advance health disparity research.
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Affiliation(s)
- Cheryl J Smith
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tsion Z Minas
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center of Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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27
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McClelland S, Page BR, Jaboin JJ, Chapman CH, Deville C, Thomas CR. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients. Adv Radiat Oncol 2017; 2:523-531. [PMID: 29204518 PMCID: PMC5707425 DOI: 10.1016/j.adro.2017.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023] Open
Abstract
Introduction African Americans experience the highest burden of cancer incidence and mortality in the United States and have been persistently less likely to receive interventional care, even when such care has been proven superior to conservative management by randomized controlled trials. The presence of disparities in access to radiation therapy (RT) for African American cancer patients has rarely been examined in an expansive fashion. Methods and materials An extensive literature search was performed using the PubMed database to examine studies investigating disparities in RT access for African Americans. Results A total of 55 studies were found, spanning 11 organ systems. Disparities in access to RT for African Americans were most prominently study in cancers of the breast (23 studies), prostate (7 studies), gynecologic system (5 studies), and hematologic system (5 studies). Disparities in RT access for African Americans were prevalent regardless of organ system studied and often occurred independently of socioeconomic status. Fifty of 55 studies (91%) involved analysis of a population-based database such as Surveillance, Epidemiology and End Result (SEER; 26 studies), SEER-Medicare (5 studies), National Cancer Database (3 studies), or a state tumor registry (13 studies). Conclusions African Americans in the United States have diminished access to RT compared with Caucasian patients, independent of but often in concert with low socioeconomic status. These findings underscore the importance of finding systemic and systematic solutions to address these inequalities to reduce the barriers that patient race provides in receipt of optimal cancer care.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
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28
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Zhang K, Bangma CH, Roobol MJ. Prostate cancer screening in Europe and Asia. Asian J Urol 2017; 4:86-95. [PMID: 29264211 PMCID: PMC5717985 DOI: 10.1016/j.ajur.2016.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the second most common cancer among men worldwide and even ranks first in Europe. Although Asia is known as the region with the lowest PCa incidence, it has been rising rapidly over the last 20 years mostly due to the introduction of prostate-specific antigen (PSA) testing. Randomized PCa screening studies in Europe show a mortality reduction in favor of PSA-based screening but coincide with high proportions of unnecessary biopsies, overdiagnosis and subsequent overtreatment. Conclusive data on the value of PSA-based screening and hence the balance between harms and benefits in Asia is still lacking. Because of known racial variations, Asian countries should not directly apply the European screening models. Like in the western world also in Asia, new predictive markers, tools and risk stratification strategies hold great potential to improve the early detection of PCa and to reduce the worldwide existing negative aspects of PSA-based PCa screening.
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Affiliation(s)
| | | | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Wong AT, Schwartz D, Osborn V, Safdieh J, Weiner J, Schreiber D. Adjuvant radiation with hormonal therapy is associated with improved survival in men with pathologically involved lymph nodes after radical surgery for prostate cancer. Urol Oncol 2016; 34:529.e15-529.e20. [DOI: 10.1016/j.urolonc.2016.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/29/2022]
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Cobran EK, Chen RC, Overman R, Meyer AM, Kuo TM, O'Brien J, Sturmer T, Sheets NC, Goldin GH, Penn DC, Godley PA, Carpenter WR. Racial Differences in Diffusion of Intensity-Modulated Radiation Therapy for Localized Prostate Cancer. Am J Mens Health 2016; 10:399-407. [PMID: 25657192 PMCID: PMC4570865 DOI: 10.1177/1557988314568184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Intensity-modulated radiation therapy (IMRT), an innovative treatment option for prostate cancer, has rapidly diffused over the past decade. To inform our understanding of racial disparities in prostate cancer treatment and outcomes, this study compared diffusion of IMRT in African American (AA) and Caucasian American (CA) prostate cancer patients during the early years of IMRT diffusion using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. A retrospective cohort of 947 AA and 10,028 CA patients diagnosed with localized prostate cancer from 2002 through 2006, who were treated with either IMRT or non-IMRT as primary treatment within 1 year of diagnoses was constructed. Logistic regression was used to examine potential differences in diffusion of IMRT in AA and CA patients, while adjusting for socioeconomic and clinical covariates. A significantly smaller proportion of AA compared with CA patients received IMRT for localized prostate cancer (45% vs. 53%, p < .0001). Racial differences were apparent in multivariable analysis though did not achieve statistical significance, as time and factors associated with race (socioeconomic, geographic, and tumor related factors) explained the preponderance of variance in use of IMRT. Further research examining improved access to innovative cancer treatment and technologies is essential to reducing racial disparities in cancer care.
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Affiliation(s)
- Ewan K Cobran
- University of Georgia, College of Pharmacy, Athens, GA, USA
| | - Ronald C Chen
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | | | - Anne-Marie Meyer
- UNC, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Tzy-Mey Kuo
- UNC, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Jonathon O'Brien
- UNC, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Til Sturmer
- UNC, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Nathan C Sheets
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - Gregg H Goldin
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - Dolly C Penn
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - Paul A Godley
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
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Ogunsanya ME, Brown CM, Odedina FT, Barner JC, Corbell B, Adedipe TB. Beliefs Regarding Prostate Cancer Screening Among Black Males Aged 18 to 40 Years. Am J Mens Health 2016; 11:41-53. [PMID: 26993999 DOI: 10.1177/1557988316637879] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to identify the salient behavioral beliefs of young Black men toward prostate cancer screening, and to identify the issues surrounding their comfortability with prostate examinations. A total of 20 Black men, aged between 18 and 40 years, participated in three focus group sessions between June 2013 and July 2013 in Austin, Texas. Participants were asked open-ended questions about: (a) the advantages and disadvantages of screening to identify salient behavioral beliefs about screening and (b) issues that would make prostate examinations comfortable or uncomfortable to identify comfortability factors. Focus group discussions were tape-recorded, transcribed, and content analyzed to identify emerging themes of salient beliefs and comfortability. Also, nine salient behavioral beliefs toward prostate cancer screening were identified, and eight factors were linked to comfortability with prostate examinations. Given the increase of prostate cancer disparity as a public health issue, understanding the beliefs of Black men of prescreening age (18-40 years) may be crucial to the effectiveness of future interventions to improve screening when recommended at later ages.
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Trinh QD, Li H, Meyer CP, Hanske J, Choueiri TK, Reznor G, Lipsitz SR, Kibel AS, Han PK, Nguyen PL, Menon M, Sammon JD. Determinants of cancer screening in Asian-Americans. Cancer Causes Control 2016; 27:989-98. [PMID: 27372292 DOI: 10.1007/s10552-016-0776-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/10/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening. METHODS Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015. RESULTS Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63-0.96), cervical (OR 0.45, 95 % CI 0.36-0.55), and prostate cancer (OR 0.55, 95 % CI 0.39-0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92-1.82) screening as compared to NHWs. CONCLUSIONS AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.
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Affiliation(s)
- Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA.
| | - Hanhan Li
- Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA
| | - Christian P Meyer
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Julian Hanske
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Gally Reznor
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Stuart R Lipsitz
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Adam S Kibel
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Scarborough, ME, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mani Menon
- Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA.,Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA
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Schmid M, Meyer CP, Reznor G, Choueiri TK, Hanske J, Sammon JD, Abdollah F, Chun FKH, Kibel AS, Tucker-Seeley RD, Kantoff PW, Lipsitz SR, Menon M, Nguyen PL, Trinh QD. Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer. JAMA Oncol 2016; 2:85-93. [PMID: 26502115 DOI: 10.1001/jamaoncol.2015.3384] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE There is extensive evidence suggesting that black men with localized prostate cancer (PCa) have worse cancer-specific mortality compared with their non-Hispanic white counterparts. OBJECTIVE To evaluate racial disparities in the use, quality of care, and outcomes of radical prostatectomy (RP) in elderly men (≥ 65 years) with nonmetastatic PCa. DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis of outcomes stratified according to race (black vs non-Hispanic white) included 2020 elderly black patients (7.6%) and 24,462 elderly non-Hispanic white patients (92.4%) with localized PCa who underwent RP within the first year of PCa diagnosis in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2009. The study was performed in 2014. MAIN OUTCOMES AND MEASURES Process of care (ie, time to treatment, lymph node dissection), as well as outcome measures (ie, complications, emergency department visits, readmissions, PCa-specific and all-cause mortality, costs) were evaluated using Cox proportional hazards regression. Multivariable conditional logistic regression and quantile regression were used to study the association of racial disparities with process of care and outcome measures. RESULTS The proportion of black patients with localized prostate cancer who underwent RP within 90 days was 59.4% vs 69.5% of non-Hispanic white patients (P < 001). In quantile regression of the top 50% of patients, blacks had a 7-day treatment delay compared with non-Hispanic whites. (P < 001). Black patients were less likely to undergo lymph node dissection (odds ratio [OR], 0.76 [95% CI, 0.66-0.80]; P < .001) but had higher odds of postoperative visits to the emergency department (within 30 days: OR, 1.48 [95% CI, 1.18-1.86]); after 30 days or more (OR, 1.45 [95% CI, 1.19-1.76]) and readmissions (within 30 days: OR, 1.28 [95% CI, 1.02-1.61]); ≥ 30 days (OR, 1.27 [95% CI, 1.07-1.51]) compared with non-Hispanic whites. The surgical treatment of black patients was associated with a higher incremental annual cost (the top 50% of blacks spent $1185.50 (95% CI , $804.85-1 $1566.10; P < .001) more than the top 50% of non-Hispanic whites). There was no difference in PCa-specific mortality (P = .16) or all-cause mortality (P = .64) between black and non-Hispanic white men. CONCLUSIONS AND RELEVANCE Blacks treated with RP for localized PCa are more likely to experience adverse events and incur higher costs compared with non-Hispanic white men; however, this does not translate into a difference in PCa-specific or all-cause mortality.
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Affiliation(s)
- Marianne Schmid
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gally Reznor
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Toni K Choueiri
- Dana-Farber Cancer Institute, Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julian Hanske
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Felix K H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Kibel
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Reginald D Tucker-Seeley
- Center for Community-Based Research, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philip W Kantoff
- Dana-Farber Cancer Institute, Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Paul L Nguyen
- Dana-Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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AlHashem H, Al-Mubarak M, Vera-Badillo F, Templeton A, Ocana A, Seruga B, Amir E. Impact of Geographic Region on Benefit of Approved Anticancer Drugs Evaluated in International Phase III Clinical Trials. Clin Oncol (R Coll Radiol) 2016; 28:283-91. [DOI: 10.1016/j.clon.2015.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 08/03/2015] [Accepted: 09/17/2015] [Indexed: 10/22/2022]
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Aktas BK, Ozden C, Bulut S, Tagci S, Erbay G, Gokkaya CS, Baykam MM, Memis A. Evaluation of Biochemical Recurrence-free Survival after Radical Prostatectomy by Cancer of the Prostate Risk Assessment Post-Surgical (CAPRA-S) Score. Asian Pac J Cancer Prev 2015; 16:2527-30. [DOI: 10.7314/apjcp.2015.16.6.2527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Trinh QD, Nguyen PL, Leow JJ, Dalela D, Chao GF, Mahal BA, Nayak M, Schmid M, Choueiri TK, Aizer AA. Cancer-specific mortality of Asian Americans diagnosed with cancer: a nationwide population-based assessment. J Natl Cancer Inst 2015; 107:djv054. [PMID: 25794888 DOI: 10.1093/jnci/djv054] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Racial disparities in cancer survival outcomes have been primarily attributed to underlying biologic mechanisms and the quality of cancer care received. Because prior literature shows little difference exists in the socioeconomic status of non-Hispanic whites and Asian Americans, any difference in cancer survival is less likely to be attributable to inequalities of care. We sought to examine differences in cancer-specific survival between whites and Asian Americans. METHODS The Surveillance, Epidemiology, and End Results Program was used to identify patients with lung (n = 130 852 [16.9%]), breast (n = 313 977 [40.4%]), prostate (n = 166 529 [21.4%]), or colorectal (n = 165 140 [21.3%]) cancer (the three leading causes of cancer-related mortality within each sex) diagnosed between 1991 and 2007. Fine and Gray's competing risks regression compared the cancer-specific mortality (CSM) of eight Asian American groups (Chinese, Filipino, Hawaiian/Pacific Islander, Japanese, Korean, other Asian, South Asian [Indian/Pakistani], and Vietnamese) to non-Hispanic white patients. All P values were two-sided. RESULTS In competing risks regression, the receipt of definitive treatment was an independent predictor of CSM (hazard ratio [HR] = 0.37, 95% confidence interval [CI] = 0.35 to 0.40; HR = 0.55, 95% CI = 0.53 to 0.58; HR = 0.61, 95% CI = 0.60 to 0.62; and HR = 0.27, 95% CI = 0.25 to 0.29) for prostate, breast, lung, and colorectal cancers respectively, all P < .001). In adjusted analyses, most Asian subgroups (except Hawaiians and Koreans) had lower CSM relative to white patients, with hazard ratios ranging from 0.54 (95% CI = 0.38 to 0.78) to 0.88 (95% CI = 0.84 to 0.93) for Japanese patients with prostate and Chinese patients with lung cancer, respectively. CONCLUSIONS Despite adjustment for potential confounders, including the receipt of definitive treatment and tumor characteristics, most Asian subgroups had better CSM than non-Hispanic white patients. These findings suggest that underlying genetic/biological differences, along with potential cultural variations, may impact survival in Asian American cancer patients.
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Affiliation(s)
- Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Paul L Nguyen
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Jeffrey J Leow
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Deepansh Dalela
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Grace F Chao
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Brandon A Mahal
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Manan Nayak
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Toni K Choueiri
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Ayal A Aizer
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
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Gupta A, Vernali S, Rand AE, Agarwal A, Qureshi MM, Hirsch AE. Effect of Patient Demographic Characteristics and Radiation Timing on PSA Reduction in Patients Treated With Definitive Radiation Therapy for Prostate Cancer. Clin Genitourin Cancer 2015; 13:364-369. [PMID: 25766484 DOI: 10.1016/j.clgc.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/16/2015] [Accepted: 01/25/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to assess how demographic characteristics and temporal factors including time to treatment (TTT) and elapsed time of treatment (ETT) affect prostate-specific antigen (PSA) levels during and after radiation treatment for low- and intermediate-risk prostate cancer. PATIENTS AND METHODS A retrospective review of 1584 patients was conducted on patients diagnosed with prostate cancer between 2005 and 2013, from which 147 patients were found to have completed definitive external beam radiation therapy (EBRT) monotherapy. Demographic data, TTT (days between diagnosis and EBRT start date), ETT (days between EBRT start and stop date), and Gleason score were collected on these patients and analysis of variance was performed to analyze the relationship of these factors with PSA changes. PSA changes were calculated during treatment as the difference between pre- and posttreatment PSA levels and after treatment as 3-year and overall PSA velocities. RESULTS Patients who spoke Haitian Creole (P = .039) and those with a longer ETT (P = .029) had significantly greater PSA decline during treatment, primarily as a result of higher pretreatment PSA levels. Patients with Gleason score 4+3 disease had significantly greater 3-year (P = .033) and overall (P = .019) PSA velocities. Race and/or ethnicity, insurance type, marital status, and age were not associated with any PSA variable. CONCLUSION Disparities in prostate cancer are not reflected in PSA dynamics during or after radiation treatment, but are evident in PSA level at presentation. Timeliness of treatment was not found to affect true PSA change due to EBRT in low- and intermediate-risk prostate cancer patients.
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Affiliation(s)
- Apar Gupta
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Steven Vernali
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Alexander E Rand
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Ankit Agarwal
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA
| | - Ariel E Hirsch
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA.
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Ailawadhi S, Swaika A, Razavi P, Yang D, Chanan-Khan A. Variable risk of second primary malignancy in multiple myeloma patients of different ethnic subgroups. Blood Cancer J 2014; 4:e243. [PMID: 25192415 PMCID: PMC4183772 DOI: 10.1038/bcj.2014.63] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 12/31/2022] Open
Abstract
Second primary malignancies (SPMs) among multiple myeloma (MM) patients have been reported with an estimated incidence varying from 1 to 15%. We have previously reported that significant disparity exists in MM survival across patients of different ethnicities. We undertook a Surveillance Epidemiology and End Results-based analysis to describe the incidence of SPMs among MM patients of different ethnicities, to explore the variable impact that SPMs might have on MM outcomes of patients across racial subgroups. We found that the risk of developing SPMs among MM patients is variable depending on the patient's ethnic background. This warrants further exploration of the impact of SPMs on outcomes of MM patients across different racial subgroups, especially in the form of prospective data collection and analyses.
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Affiliation(s)
- S Ailawadhi
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - A Swaika
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - P Razavi
- Division of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D Yang
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Chanan-Khan
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
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