Influence of neighborhood social and natural environment on prostatic tumor histology in a US-based cohort of male health professionals

Abstract

BACKGROUND AND AIM Neighborhood social and physical environments may contribute to prostate cancer (CaP), but biological mechanisms remain unclear. We examined associations between neighborhood factors and inflammation-related prostatic histology. METHODS Men diagnosed with CaP from 1986-2009 in the Health Professionals Follow-up Study were included. Addresses, demographic, clinical, and lifestyle data were provided through biennial questionnaires. Decennial census data were used to estimate neighborhood socioeconomic status (nSES) based on a summary z-scaled measure of nine census tract-level measures of income, wealth, education, and racial composition. Segregation was estimated using census tract-level Index of Concentration at Extremes (ICE). Neighborhood greenness within 270 meters of the participants’ address was estimated using seasonal averaged Landsat Normalized Difference Vegetation Index (NDVI). Slides containing surgical tissue underwent a standardized histopathologic review. Chronic inflammation was assessed based on increasing presence of mononuclear cells. Focal atrophy was assessed through Simple Atrophy (SA), Simple Atrophy with Cyst Formation (SACF), and Postatrophic Hyperplasia (PAH). Exposures were assessed at baseline and using updated cumulative averages. Adjusted odds ratios (aOR) for inflammation (nominal) and focal atrophy (binary) measures were estimated from covariate-adjusted logistic regression models, per interquartile range (IQR) increase in each exposure. RESULTS Among 967 CaP cases with ≥1 lesion, each IQR increase in baseline NDVI (aOR: 0.76, 95% CI: 0.59, 0.98), Income-ICE (aOR: 0.79, 95% CI: 0.61, 1.04) and Race/Income ICE (aOR: 0.79, 95% CI: 0.63, 0.99) was associated with lower PAH. An IQR increase in nSES was associated with lower SACF (aOR: 0.77, 95% CI: 0.60, 0.99). No associations were observed for chronic inflammation. Associations using cumulative updated average exposures were weaker for NDVI but similar for nSES and ICE. CONCLUSIONS Favorable neighborhood socioeconomic and natural environments were associated with lower PAH but not other prostatic lesions. Prostatic inflammation arising from environmental sources may result in distinct pathological signatures.