Disparities In Prostate Cancer Outcomes Research Articles

A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts.

Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.

The effect of limited english proficiency on prostate-specific antigen screening in American men.

To evaluate how limited English proficiency (LEP) impacts the prevalence of prostate-specific antigen (PSA) screening in a contemporary, nationally representative cohort of men in the USA. The Medical Expenditure Panel Survey was utilized to identify the prevalence of PSA screening between 2013 and 2016 among men ≥ 55. Men who speak a language other than English at home were stratified by self-reported levels of English proficiency (men who speak English very well, well, not well, or not at all). Survey weights were applied, and groups were compared using the adjusted Wald test. A multivariable logistic regression model was used to identify predictors of PSA screening adjusting for patient-level covariates. The cohort included 2,889 men, corresponding to a weighted estimate of 4,765,682 men. 79.6% of men who speak English very well reported receiving at least one lifetime PSA test versus 58.4% of men who do not speak English at all (p < 0.001). Men who reported not speaking English at all had significantly lower prevalence of PSA screening (aOR 0.56; 95% CI 0.35-0.91; p = 0.019). Other significant predictors of PSA screening included older age, income > 400% of the federal poverty level, insurance coverage, and healthcare utilization. Limited English proficiency is associated with significantly lower prevalence of PSA screening among men in the USA. Interventions to mitigate disparities in prostate cancer outcomes should account for limited English proficiency among the barriers to guideline-concordant care.

Abstract A070: The influence of cultural factors on health-seeking behaviors regarding prostate cancer among African immigrant men in the United States

Abstract Background: The increasing number of African immigrants in the United States has contributed to the diversity of the country's Black population. However, there is limited research on the impact of immigration, particularly regarding chronic diseases like cancer, within the sub-Saharan African immigrant (SSAI) community. To address this gap, this study aimed to explore cultural factors among SSAIs to better understand the drivers of health disparities in prostate cancer outcomes. Methods: A qualitative approach using grounded theory was employed for this study. Participants were purposefully recruited to reflect the cultural diversity among SSAIs. Recruitment occurred at health fairs, community events and by snowball approach. In-depth interviews were conducted with 16 participants, including prostate cancer survivors. Nine participants have lived in the US for at least 10 years. The average age of participants was 51 years. Country of birth for study participants include, Nigeria, Ghana, Cameroon, Kenya, and Ethiopia. Interviews were transcribed, verified, and de-identified then imported into NVivo 12 software. Four research team members, three of them African immigrants, performed open and axial coding, with consensus on the emerging findings. Results: This study identified several key cultural factors influencing SSAI men’s health behaviors. These factors include the perception of cancer in their country of birth, the low priority given to preventative care in their country of origin, and reluctance to embrace a Westernized diet, the perception of cancer in their country of origin as a death sentence, viewing cancer as a spiritual/religious attack, and associating cancer with affluence. In addition, these cultural factors made participants hesitant to discuss cancer, relying on religion for healing instead of medical care, and seeking healthcare only for cure. Conclusion: This study illuminates key cultural factors among SSAI men that influence their health-seeking behaviors. These findings highlight the need for culturally tailored behavioral interventions to address these factors and improve health outcomes within this understudied population. Citation Format: Ernest Kaninjing, Motolani Ogunsanya, Kaitlin Van Voorhis, Gladys Asiedu, Assata Kokayi, Rae Walker Brennan, Mary Ellen Young, Folake Odedina. The influence of cultural factors on health-seeking behaviors regarding prostate cancer among African immigrant men in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A070.

MP12-10 THE EFFECT OF LIMITED ENGLISH PROFICIENCY ON PSA SCREENING RATES IN AMERICAN MEN

You have accessJournal of UrologyCME1 Apr 2023MP12-10 THE EFFECT OF LIMITED ENGLISH PROFICIENCY ON PSA SCREENING RATES IN AMERICAN MEN Benjamin V. Stone, Muhieddine Labban, Dejan K. Filipas, Edoardo Beatrici, Nicola Frego, Zhiyu (Jason) Qian, Sandeep S. Voleti, Stuart R. Lipsitz, Adam S. Kibel, Alexander P. Cole, and Quoc-Dien Trinh Benjamin V. StoneBenjamin V. Stone More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Nicola FregoNicola Frego More articles by this author , Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Sandeep S. VoletiSandeep S. Voleti More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There exist disparities in prostate-specific antigen (PSA) screening and prostate cancer outcomes among racial and ethnic groups, but it is unknown how limited English proficiency impacts rates of PSA screening. METHODS: The Medical Expenditure Panel Survey was utilized to identify rates of PSA screening between 2013 and 2016 among men without prostate cancer ≥55 for whom guidelines recommend shared decision-making regarding prostate cancer screening. Men were stratified by self-reported levels of English proficiency (men who speak English very well, well, not well, or not at all). Survey weights were applied, and groups were compared using the adjusted Wald test. A multivariable logistic regression model was used to identify predictors of ever receiving PSA screening adjusting for patient-level covariates. RESULTS: The cohort included 2,889 men, corresponding to a weighted national estimate of 4,765,682 men. The rates of PSA screening varied significantly according to levels of English proficiency (p<0.0001, Figure 1). 79.6% of men who speak English very well reported receiving at least one lifetime PSA test, compared with 58.4% of men who do not speak English at all (p<0.001). Approximately half of the men who speak English very well reported PSA testing within the prior year (52.0%) compared with 34.5% of men who do not speak English at all. Significant predictors of receiving at least one lifetime PSA test included older age, income >400% of the federal poverty level, and insurance coverage (Table 1). Asian compared to White race was associated with lower rates of PSA screening (aOR 0.35; 95% CI 0.21-0.60; p<0.001). Compared to those who reported speaking English very well, men who reported not speaking English at all had significantly lower rates of PSA screening (aOR 0.55; 95% CI 0.35-0.88; p=0.012). CONCLUSIONS: Limited English proficiency is associated with significantly lower rates of PSA screening. Interventions to mitigate disparities in prostate cancer outcomes need to account for limited English proficiency among the barriers to guideline-concordant care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e137 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin V. Stone More articles by this author Muhieddine Labban More articles by this author Dejan K. Filipas More articles by this author Edoardo Beatrici More articles by this author Nicola Frego More articles by this author Zhiyu (Jason) Qian More articles by this author Sandeep S. Voleti More articles by this author Stuart R. Lipsitz More articles by this author Adam S. Kibel More articles by this author Alexander P. Cole More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Race and prostate cancer: genomic landscape.

In the past 20 years, new insights into the genomic pathogenesis of prostate cancer have been provided. Large-scale integrative genomics approaches enabled researchers to characterize the genetic and epigenetic landscape of prostate cancer and to define different molecular subclasses based on the combination of genetic alterations, gene expression patterns and methylation profiles. Several molecular drivers of prostate cancer have been identified, some of which are different in men of different races. However, the extent to which genomics can explain racial disparities in prostate cancer outcomes is unclear. Future collaborative genomic studies overcoming the underrepresentation of non-white patients and other minority populations are essential.

Health inequity drives disease biology to create disparities in prostate cancer outcomes.

Prostate cancer exerts a greater toll on African American men than on White men of European descent (hereafter referred to as European American men): the disparity in incidence and mortality is greater than that of any other common cancer. The disproportionate impact of prostate cancer on Black men has been attributed to the genetics of African ancestry, to diet and lifestyle risk factors, and to unequal access to quality health care. In this Review, all of these influences are considered in the context of the evolving understanding that chronic or recurrent inflammatory processes drive prostatic carcinogenesis. Studies of inherited susceptibility highlight the contributions of genes involved in prostate cell and tissue repair (BRCA1/2, ATM) and regeneration (HOXB13 and MYC). Social determinants of health appear to accentuate these genetic influences by fueling prostate inflammation and associated cell and genome damage. Molecular characterization of the prostate cancers that arise in Black versus White men further implicates this inflammatory microenvironment in disease behavior. Yet, when Black and White men with similar grade and stage of prostate cancer are treated equally, they exhibit equivalent outcomes. The central role of prostate inflammation in prostate cancer development and progression augments the impact of the social determinants of health on disease pathogenesis. And, when coupled with poorer access to high-quality treatment, these inequities result in a disparate burden of prostate cancer on African American men.

Racial and Ethnic Disparities in Prostate Cancer Outcomes in the Veterans Affairs Health Care System

Prostate cancer (PCa) disproportionately affects African American men, but research evaluating the extent of racial and ethnic disparities across the PCa continuum in equal-access settings remains limited at the national level. The US Department of Veterans Affairs (VA) Veterans Hospital Administration health care system offers a setting of relatively equal access to care in which to assess racial and ethnic disparities in self-identified African American (or Black) veterans and White veterans. To determine the extent of racial and ethnic disparities in the incidence of PCa, clinical stage, and outcomes between African American patients and White patients who received a diagnosis or were treated at a VA hospital. This retrospective cohort study included 7 889 984 veterans undergoing routine care in VA hospitals nationwide from 2005 through 2019 (incidence cohort). The age-adjusted incidence of localized and de novo metastatic PCa was estimated. Treatment response was evaluated, and PCa-specific outcomes were compared between African American veterans and White veterans. Residual disparity in PCa outcome, defined as the leftover racial and ethnic disparity in the outcomes despite equal response to treatment, was estimated. Self-identified African American (or Black) and White race and ethnicity. Time to distant metastasis following PCa diagnosis was the primary outcome. Descriptive analyses were used to compare baseline demographics and clinic characteristics. Multivariable logistic regression was used to evaluate race and ethnicity association with pretreatment clinical variables. Multivariable Cox regression was used to estimate the risk of metastasis. Data from 7 889 984 veterans from the incidence cohort were used to estimate incidence, whereas data from 92 269 veterans with localized PCa were used to assess treatment response. Among 92 269 veterans, African American men (n = 28 802 [31%]) were younger (median [IQR], 63 [58-68] vs 65 [62-71] years) and had higher prostate-specific antigen levels (>20 ng/mL) at the time of diagnosis compared with White men (n = 63 467; [69%]). Consistent with US population-level data, African American veterans displayed a nearly 2-fold greater incidence of localized and de novo metastatic PCa compared with White men across VA centers nationwide. Among veterans screened for PCa, African American men had a 29% increased risk of PCa detection on a diagnostic prostate biopsy compared with White (hazard ratio, 1.29; 95% CI, 1.27-1.31; P < .001). African American men who received definitive primary treatment of PCa experienced a lower risk of metastasis (hazard ratio, 0.89; 95% CI, 0.83-0.95; P < .001). However, African American men who received nondefinitive treatment classified as “other” were more likely to develop metastasis (adjusted hazard ratio, 1.29; 95% CI, 1.17-1.42; P < .001). Using the actual rate of metastasis from veterans who received definitive primary treatment, a persistent residual metastatic burden for African American men was observed across all National Comprehensive Cancer Network risk groups (low risk, 4 vs 2 per 100 000; intermediate risk, 13 vs 6 per 100 000; high risk, 19 vs 9 per 100 000). This cohort analysis found significant disparities in the incidence of localized and metastatic PCa between African American veterans and White veterans. This increased incidence is a major factor associated with the residual disparity in PCa metastasis observed in African American veterans compared with White veterans despite their nearly equal response to treatment.

Testing a Prostate Cancer Educational Intervention in High-Burden Neighborhoods.

To better capitalize on our enhanced understanding of prostate cancer (PCa) risk factors, it is important to better understand how knowledge and attitudes contribute to ethnic disparities in PCa outcomes. The goal of this study was to test the impact of a targeted PCa educational intervention vs. a healthy lifestyle educational control intervention on levels of knowledge, concern, and intention to screen for PCa.We recruited 239 men from neighborhoods with the highest PCa burden in Philadelphia. We assigned 118 men from two of the neighborhoods to the control group 121 men from 2 other neighborhoods to the intervention group. Repeated outcome assessment measures were obtained by administering the survey at baseline, post-session, 1month post-session, and 4months post-session.We conducted descriptive statistics to characterize the study sample and linear mixed effect regression models to analyze the intervention's effect on the outcomes. At baseline, we observed no differences in the outcomes between the PCa-targeted intervention and healthy lifestyle control groups.We found that knowledge of PCa and intention to screen increased significantly over time for both the control and intervention groups (p ≤ 0.01 at the 4-month follow-up). In contrast, change in the level of PCa concern was only significant for the intervention group immediately post-session and at 1-month follow-up (p = 0.04 and p = 0.01, respectively).This study showed that gathering at-risk men for discussions about PCa or other health concerns may increase their PCa knowledge and intention to talk to a doctor about PCa screening.

Association of race with receipt of definitive therapy for high risk prostate cancer in older men

ObjectivesBlack men are more likely to die of prostate cancer (PCa) than White men. Whether this difference is driven by biological versus sociodemographic and access to care differences is actively investigated. However, studies that have highlighted racial disparities in PCa outcomes have been poorly represented by elderly men, a notoriously undertreated group. Herein, we evaluated use of curative treatment between Black and White elderly men with aggressive PCa in a large US database. MethodsMen ≥80 years diagnosed with National Comprehensive Cancer Network-defined high risk PCa between 2004 and 2016 were analyzed from the National Cancer Database. Multivariable logistic regression was used to model the effect of race and sociodemographic factors on receipt of definitive therapy (surgery or radiation +/− androgen deprivation therapy [ADT]) versus non-definitive therapy (ADT alone or observation) in inverse probability weighted groups matched for stage, prostate-specific antigen, and Gleason score. ResultsBetween 2004 and 2016, utilization of definitive therapy with either surgery or radiation therapy increased in both White and Black men in the United States. However, we found that Black men compared with White men were significantly less likely to receive definitive therapy (OR 0.71, 95% CI 0.64–0.79, p < .001). Using multivariable modeling, effect size diminished after adjusting for sociodemographic variables. Notably, there is evidence of the racial disparity narrowing over time. ConclusionsThese findings highlight striking but improving racial disparities in elderly men with high risk PCa in the US, an overall undertreated population.

MP60-05 MOLECULAR PROFILING OF PROSTATE CANCER REVEALS INCREASED INFLAMMATORY MARKERS AND POOR CLINICAL OUTCOMES IN AFRICAN AMERICAN COMPARED TO EUROPEAN AMERICAN MEN

You have accessJournal of UrologyProstate Cancer: Markers (MP60)1 Sep 2021MP60-05 MOLECULAR PROFILING OF PROSTATE CANCER REVEALS INCREASED INFLAMMATORY MARKERS AND POOR CLINICAL OUTCOMES IN AFRICAN AMERICAN COMPARED TO EUROPEAN AMERICAN MEN Udit Singhal, Srinivas Nallandhighal, Susan Bolton, Mark Farha, Judith Strangl-Kremser, Ganesh Palapattu, Aliccia Bollig-Fischer, Aaron Udagar, Isaac Powell, and Simpa Salami Udit SinghalUdit Singhal More articles by this author , Srinivas NallandhighalSrinivas Nallandhighal More articles by this author , Susan BoltonSusan Bolton More articles by this author , Mark FarhaMark Farha More articles by this author , Judith Strangl-KremserJudith Strangl-Kremser More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , Aliccia Bollig-FischerAliccia Bollig-Fischer More articles by this author , Aaron UdagarAaron Udagar More articles by this author , Isaac PowellIsaac Powell More articles by this author , and Simpa SalamiSimpa Salami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002095.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: African American men (AAM) with prostate cancer (PCa) often harbor more aggressive disease compared to European American men (EAM). However, the underlying cause for disparities in PCa outcomes is controversial. We performed gene expression analysis to characterize differences in tumor biology in AAM and EAM with PCa and assess the impact on outcomes. METHODS: Microarray analyses using 1,507 probes were performed to assess the expression of 517 genes in PCa radical prostatectomy (RP) specimens from 270 AAM and 369 EAM from 1991-1996. The primary endpoint was biochemical recurrence (BCR) and secondary endpoint was PCa-specific mortality (PCSM). Cox proportional hazard regression analyses were performed adjusting for age, pre-treatment PSA, Gleason grade group (GG), and T-stage. Differential Gene Expression (DEG) analysis was performed using the limma R package, with correction for multiple comparisons using the Benjamini-Hochberg procedure (false-discovery rate (FDR) of <0.05 considered significant). Gene Set Enrichment Analysis (GSEA) was performed to identify enriched hallmark pathways using R package fgsea. RESULTS: The median age of AAM and EAM was 64 (IQR 56-72) and 62 (IQR 54-70) years, respectively. A total of 66 (24%) AAM and 67 (18%) EAM developed BCR (p=0.002; median follow up 10.5 and 13.8 years, respectively). Sixteen men experienced PCSM in each group (5.9% and 4.3% in AAM and EAM, respectively; p=0.080). Interestingly, among those with GG1-2 disease, AAM were more likely to develop BCR than EAM (HR 2.3, 95% CI 1.3–4, p=0.004). However, the BCR risk was not significantly different between AAM and EAM with GG3-5 disease (p=0.370). DEG and GSEA revealed upregulation of inflammation, TNF-alpha signaling, apoptosis, androgen response, and epithelial to mesenchymal transition, among other pathways, in AAM compared to EAM (Figure 1; FDR <0.05). CONCLUSIONS: AAM with GG1-2 PCa had a higher incidence of BCR compared with EAM following RP, suggesting a more aggressive biologic behavior in AAM in early disease. The molecular profile of PCa in AAM is different from that in EAM, with inflammation playing a prominent role. Prognostic gene signatures accounting for these biological differences are needed to facilitate better disease management. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1042-e1043 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Udit Singhal More articles by this author Srinivas Nallandhighal More articles by this author Susan Bolton More articles by this author Mark Farha More articles by this author Judith Strangl-Kremser More articles by this author Ganesh Palapattu More articles by this author Aliccia Bollig-Fischer More articles by this author Aaron Udagar More articles by this author Isaac Powell More articles by this author Simpa Salami More articles by this author Expand All Advertisement Loading ...

Long‐term depression incidence and associated mortality among African American and White prostate cancer survivors

Depression is common after a diagnosis of prostate cancer and may contribute to poor outcomes, particularly among African Americans. The authors assessed the incidence and management of depression and its impact on overall mortality among African American and White veterans with localized prostate cancer. The authors used the Veterans Health Administration Corporate Data Warehouse to identify 40,412 African American and non-Hispanic White men diagnosed with localized prostate cancer from 2001 to 2013. Patients were followed through 2019. Multivariable logistic regression was used to measure associations between race and incident depression, which were ascertained from administrative and depression screening data. Cox proportional hazards models were used to measure associations between incident depression and all-cause mortality, with race-by-depression interactions used to assess disparities. Overall, 10,013 veterans (24.5%) were diagnosed with depression after a diagnosis of prostate cancer. Incident depression was associated with higher all-cause mortality (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.23-1.32). African American veterans were more likely than White veterans to be diagnosed with depression (29.3% vs 23.2%; adjusted odds ratio [aOR], 1.15; 95% CI, 1.09-1.21). Among those with depression, African Americans were less likely to be prescribed an antidepressant (30.4% vs 31.7%; aOR, 0.85; 95% CI, 0.77-0.93). The hazard of all-cause mortality associated with depression was greater for African American veterans than White veterans (aHR, 1.32 [95% CI, 1.26-1.38] vs 1.15 [95% CI, 1.07-1.24]; race-by-depression interaction P < .001). Incident depression is common among prostate cancer survivors and is associated with higher mortality, particularly among African American men. Patient-centered strategies to manage incident depression may be critical to reducing disparities in prostate cancer outcomes.

Understanding racial disparities in survival among U.S. veterans with localized high-risk prostate cancer, 2004-2019.

202 Background: Known racial disparities in prostate cancer outcomes between African-American (AA) and non-Hispanic White (W) men may be ameliorated in the Veterans Health Administration (VA), a large national equal-access health system. We examined factors contributing to racial disparities in mortality among men with high-risk localized prostate cancer diagnosed in the VA. Methods: In this retrospective cohort study, we used linked administrative, survey, and electronic health record data from the Veterans Health Administration (VA) Corporate Data Warehouse to identify AA and W Veterans who were diagnosed with high-risk localized PC, as defined by D’Amico criteria, between January 1, 2004 and December 31, 2013. Patients were followed through December 31, 2019. The primary outcome was all-cause mortality. We used hierarchical Cox regression models, sequentially adjusting for covariates related to social determinants of health (e.g. travel time, marital status), clinical factors at diagnosis (e.g. PSA, Gleason, comorbidity), diagnosing facility, and prostate cancer treatment and adherence to American Cancer Society survivorship care guidelines. Results: Among 21,338 Veterans receiving continuous VA-based care (median age at diagnosis 66 years [interquartile range [IQR] 61-74]), 7,472 (28.7%) were AA, 9,404 (44.1%) died, and median follow-up was 8.4 years (IQR 6.1-11.1). After adjusting for all covariates, AA Veterans (adjusted hazard ratio [aHR] 0.84, 95% confidence interval [CI] 0.83-0.91) had improved overall survival compared to W Veterans. This association persisted in all hierarchical regressions (see Table), was present in all pre-specified subgroups, and was strongest among Veterans living in rural domiciles (aHR 0.70, 95% CI 0.64-0.77). Conclusions: AA Veterans with high-risk localized prostate cancer had improved long-term survival compared to W Veterans, which stands in contrast to prior studies among non-Veterans. Equal access to care may improve racial disparities in prostate cancer, although future studies should clarify mechanisms of improved survival for AA Veterans with prostate cancer in order to provide insights for ameliorating outcome disparities in non-Veterans with prostate cancer. [Table: see text]

Racial disparities in depression incidence, management, and mortality after prostate cancer diagnosis.

201 Background: Depressive disorder is a common cause of morbidity among men with prostate cancer (PC) and may contribute to known racial disparities in PC outcomes. We estimated the incidence, management, and impact of depressive disorder (depression) on overall mortality among African American (AA) and non-Hispanic White (W) Veterans with localized PC. Methods: In this retrospective cohort study, we used linked administrative, survey, and electronic health record data from the Veterans Health Administration (VA) Corporate Data Warehouse to identify AA and W Veterans with no preexisting depression who were diagnosed with localized PC between January 1, 2004 and December 31, 2013. Patients were followed through December 31, 2019. The primary outcomes were incident depression (defined from diagnosis codes and PHQ-2 and -9 screenings between six months to five years after PC diagnosis), receipt of anti-depressant therapy, and all-cause mortality. We used logistic and Cox regression models, adjusted for sociodemographic factors, PSA, Gleason score, and prostate cancer treatment, to estimate associations with all outcomes, using race-by-depression and race-by-treatment interaction terms to investigate racial disparities. Results: Among 32,194 Veterans diagnosed with localized prostate cancer (median age 67 years [interquartile range [IQR] 62 to 73 years], median follow-up 9.9 years [IQR 8.0 to 12.1 years]), 8,177 (25.4%) were AA. Overall, 8,285 (25.7%) Veterans were diagnosed with depression after PC diagnosis, and 2,525 (30.5%) of depressed Veterans received an antidepressant. Compared to Veterans without depression, Veterans with incident depression had higher all-cause mortality (adjusted hazard ratio [aHR] 1.30 [95% CI 1.25-1.35]). Race moderated all outcomes: AAs were more likely than Ws to be diagnosed with depression. However, among those with depression, AAs were less likely than Ws to receive an antidepressant. Interaction analyses showed that the HR of all-cause mortality associated with depression among AAs was significantly greater than that of Ws. Antidepressant receipt was not associated with improved mortality (aHR 1.05 [95% CI 0.97-1.13]); this finding was not moderated by race. Conclusions: Depression was common among men with prostate cancer within a large equal-access health care system, and African American men had more adverse depression-related outcomes than White men. Identifying and managing incident depression should be a key target of efforts to improve prostate cancer outcomes and disparities. [Table: see text]

Tobacco and marijuana use and their association with serum prostate-specific antigen levels among African American men in Chicago.

African American (AA) men experience more than twice the prostate cancer mortality as White men yet are under-represented in academic research involving prostate-specific antigen (PSA), a biomarker of prostate cancer aggressiveness. We examined the impact of self-reported tobacco (cigarette pack-years and current tobacco use including e-cigarettes) and current regular marijuana use on serum PSA level based on clinical laboratory testing among 928 AA men interviewed 2013-2018 in Chicago. We defined outcome of elevated PSA ≥ 4.0 ng/mL for logistic regression models and continuous PSA increases for general linear models. All models were adjusted for age, sociodemographic characteristics, healthcare utilization, body mass index, and self-reported health. Among 431 AA men age ≥ 55 years, we observed ∼ 5 times the odds of elevated PSA among those with > 1 pack-years of cigarette smoking vs. never-smokers (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 1.57-16.6) and a quarter the odds of elevated PSA among current marijuana users vs. non-users (OR = 0.27; 95% CI = 0.08-0.96). PSA increased on average 1.20 ng/mL among other current tobacco users vs. non-users. Among older AA men, cigarette smoking history and current tobacco use were positively associated with an increase in PSA levels and current marijuana use were inversely associated with PSA levels. Future work with studies of diverse patient populations with cancer outcomes are needed to assess whether these behavioral characteristics contribute to racial/ ethnic disparities in prostate cancer outcomes. Our study provides novel evidence regarding potential differences in PSA levels among older AA men according to behavioral characteristics.

Abstract A088: Centrosomes take center stage: Comparative analysis of centrosome amplification in African American and European American patients with prostate cancer

Abstract Background: Prostatic adenocarcinoma (PCA) in African Americans (AA) is characterized by earlier onset, higher aggressiveness, more frequent metastases, and increased mortality rates compared to those in European Americans (EA). Exome and genome sequencing have revealed that PCA in AAs also exhibits high intratumor heterogeneity (ITH) than their counterparts in EAs. ITH poses challenges to both clinicians and drug developers when identifying low-level clones, predicting tumor evolution, developing clone-specific targeted drugs and evaluating effective, yet non-toxic combinatorial regimens to combat ITH. Amplified centrosomes (an abnormal increase in the number and/or volume of centrosomes) underlie erroneous mitoses and fuel chromosomal instability (CIN), which is a well-recognized driver of ITH. In this study, we evaluated the extent of centrosome amplification in tissue sections from PCA in AA and EA men. Design: We have pioneered a semi-automated pipeline that integrates immunofluorescence confocal microscopy with digital image analysis and yields a quantitative Centrosomal Amplification Score (CAS) for each tumor sample by evaluating severity and frequency of centrosomal aberrations therein. To this end, 115 formalin fixed paraffin embedded PCA tissue sections were firstly immunofluorescently stained for centrosomes followed by imaging and image analysis. Finally, we generated a composite CAS score (CAStotal) for each patient sample by integrating the numerical (CASi) and structural (CASm) aberrations. Results: High BMI (&amp;gt;25) AA PCAs (n=37) exhibited significantly (p=0.04) higher CAStotal than EA (n=41) regardless of Gleason grade. Moreover, on analysis of grade matched PCAs we observed that CASm and CAStotal were significantly higher (p=0.02) in high grade (Gleason score &amp;gt;7) in AA PCAs (n=34) when compared to EA (n=38) PCAs. Regardless of race tumors from men &amp;gt; 54 years exhibited higher CAStotal (p=0.03) (high age group n=86 and low age =29). Conclusion: Our results suggest that AAs exhibit higher degree and severity of CA compared to EAs, which may render PCAs in AAs more sensitive to centrosome targeting/declustering drugs. This study suggests the potential usefulness of CAS in enabling patient stratification into more optimal treatment regimens and provides a novel tool that might help in personalized prostate cancer treatment with an overall goal of eliminating ethnic disparities in prostate cancer outcomes. Citation Format: Karuna Mittal, Guanhao Wei, Jaspreet Kaur, Michelle Dian Reid, Ritu Aneja. Centrosomes take center stage: Comparative analysis of centrosome amplification in African American and European American patients with prostate cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A088.

MP51-18 DIFFERENTIAL EXPRESSION PROFILING OF LNCRNA IN PRIMARY PROSTATE CANCER BASED ON BLACK AND WHITE RACE

You have accessJournal of UrologyProstate Cancer: Basic Research & Pathophysiology II (MP51)1 Apr 2020MP51-18 DIFFERENTIAL EXPRESSION PROFILING OF LNCRNA IN PRIMARY PROSTATE CANCER BASED ON BLACK AND WHITE RACE Adam Weiner*, Eddie-Luidy Imada, Edward Schaeffer, and Luigi Marchionni Adam Weiner*Adam Weiner* More articles by this author , Eddie-Luidy ImadaEddie-Luidy Imada More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , and Luigi MarchionniLuigi Marchionni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000913.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Black men are more likely to be diagnosed with and die from prostate cancer (PC) compared to white men. Long, non-coding RNAs (lncRNAs) govern gene expression with increasingly noted relevance in cancer biology. To better understand biological factors driving racial disparities in PC outcomes, we performed a differential expression and functional analysis of lncRNAs based on race. METHODS: We utilized the FANTOM-CAT/recount2 atlas, a powerful resource combining data on expression profiles for over 100,000 genes and the functional characterization of human coding and non-coding transcriptomes. From data on primary PC in 43 black men and 270 white men within the Cancer Genome Atlas, differential gene expression analyses were performed with negative binomial generalized linear models and quasi-likelihood F-test. Genes with FDR <= 0.05 were considered differentially expressed. ChIPBase data were leveraged to classify lncRNAs as androgen responsive if an androgen receptor regulatory domain was within 10 kb up- or 1 kb down-stream of the lncRNAs’ transcription start site. RESULTS: In total, 182 lncRNA were differentially expressed in PC from black men (Figure). Of these, 112 were annotated as gene promoters and/or enhancers. Based on ChIPBase data, 8 of these annotated lncRNAs were classified as androgen responsive, all of which were expressed more than 10-fold in black men (RP11-1055B8.4, RP11-131N11.4, RP11-131N11.4, RP11-131N11.4, RP11-359J6.1, RP11-359J6.1, RP11-536I6.2, and RP11-536I6.2). CONCLUSIONS: We provide a comprehensive differential expression and functional analysis of lncRNAs in primary PC based on race. Most of these lncRNAs were annotated as gene promoters and/or enhancers and several are potentially androgen responsive. These results suggest a unique pathway for PC progression in black men regulated by lncRNA, each of which represents potential biomarkers and targets for therapeutics. Source of Funding: National Institutes of Health grant 5U01CA196390 and the Prostate Cancer Foundation (EMS) as well as the 2019 Urology Care Foundation Residency Research Award Program and the Russell Scott, Jr., MD Urology Research Fund (ABW). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e770-e771 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Weiner* More articles by this author Eddie-Luidy Imada More articles by this author Edward Schaeffer More articles by this author Luigi Marchionni More articles by this author Expand All Advertisement PDF downloadLoading ...

The need for cell lines from diverse ethnic backgrounds for prostate cancer research.

Cell lines are valuable tools for developing treatments to minimize disparities in prostate cancer outcomes. Nevertheless, limitations in their application, primarily from the inadequate use of ethnically diverse cell lines, continue to hinder the advance of drug leads that would equally benefit men from both African and European ancestry.

Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer.

Racial differences in prostate cancer (PCa) outcomes in the United States may be due to differences in tumor biology and race-based differences in access and treatment. We designed a study to estimate the relative contribution of these factors on Black/White disparities in overall survival (OS) in advanced PCa. We identified Black and White men aged ≥ 40 years with metastatic or locally advanced PCa (cN+ cM+ and/or T3/4) between 2004 and 2010 using the National Cancer Database. We employed sequential propensity score weighting procedures to generate simulated cohorts of Black and White patients with equal demographics, access to care, treatment, and tumor characteristics. Adjusted survival analyses were used to compare survival in these simulated cohorts. The changes in relative survival after each weighting procedure were used to infer the contribution of each set of variables on the excess risk of mortality in Blacks. In total, 35,611 men met inclusion criteria, 5927 (16.77%) of whom were Black. Survival was significantly worse for Black men after adjusting for demographics and comorbidities (hazard ratio (HR) 1.27, 95%-confidence interval (95%-CI) 1.2-1.34, p < 0.001). After simulating equal access to care, there was no significant difference in survival between races (HR 1.04, 95%-CI 0.97-1.12, p = 0.276), despite worse tumor characteristics in Blacks. After simulating equal treatment and equivalent tumor characteristics, Black men had a better survival than Whites (HR 0.93, 95%-CI 0.86-1.01, p = 0.071 and HR 0.92, 95%-CI 0.84-1.00, p = 0.043, respectively). Overall, access-related variables explained 84.7% of the excess risk of death in Black men. Our analysis of men with advanced PCa revealed worse OS among Blacks. However, when access to care, treatment, and cancer characteristics are accounted for, Black race was associated with better OS. These findings suggest that initiatives to improve access to care may represent an effective tool to reduce disparities in PCa outcomes.

Racial variation in receipt of quality radiation therapy for prostate cancer.

Racial disparities are apparent in the management and outcomes for prostate cancer; however, disparities in compliance to quality measures for radiation therapy for prostate cancer have not been previously studied. Therefore, the goal of the study was to characterize disparities in the compliance rates with quality measures. The comparative effectiveness analysis of radiation therapy and surgery study is a population-based, prospective cohort study that enrolled 3708 men with clinically localized prostate cancer from 2011 to 2012. Compliance with 5 radiation-specific quality measures endorsed by national consortia as of 2011 was assessed, and compliance was compared by race using logistic regression. Overall, 604 men received definitive external beam radiation therapy (EBRT) of which 20% were self-reported black, 74% non-Hispanic white, and 6% Hispanic. Less than two-thirds of black and Hispanic men received EBRT that was compliant with all available quality measures (p = 0.012). Compared to white men, black men were less likely to receive dose-escalated EBRT (95% vs. 87%, p = 0.011) and less likely to avoid unnecessary pelvic radiation for low-risk disease (99% vs. 20%, p < 0.001). Compared to white men, Hispanic men were less likely to undergo image guidance (87% vs. 71%, p = 0.04). Black and Hispanic men were more likely to receive EBRT from low-quality providers than white men. Addressing disparities in access to providers that meet quality guidelines, and improving adherence to evidence-based processes of care may decrease racial/ethnic disparities in prostate cancer outcomes.

The comparative effectiveness of decision aids in diverse populations with early stage prostate cancer: a study protocol for a cluster-randomized controlled trial in the NCI Community Oncology Research Program (NCORP), Alliance A191402CD

BackgroundTreatments for localized prostate cancer present challenging tradeoffs in the face of uncertain treatment benefits. These options are best weighed in a process of shared decision-making with the patient’s healthcare team. Minority men experience disparities in prostate cancer outcomes, possibly due in part to a lack of optimal communication during treatment selection. Decision aids facilitate shared decision-making, improve knowledge of treatment options, may increase satisfaction with treatment choice, and likely facilitate long-term quality of life.Methods/designThis study will compare the effect of two evidence-based decision aids on patient knowledge and on quality of life measured one year after treatment, oversampling minority men. One decision aid will be administered prior to specialist consultation, preparing patients for a treatment discussion. The other decision aid will be administered within the consultation to facilitate transparent, preference-sensitive, and evidence-informed deliberations. The study will utilize a four-arm, block-randomized design to test whether each decision aid alone (Arms 1 and 2) or in combination (Arm 3) can improve patient knowledge and quality of life compared to usual care (Arm 4). The study, funded by the National Cancer Institute’s Community Oncology Research Program (NCORP), will be deployed within select institutions that have demonstrated capacity to recruit minority populations into urologic oncology trials.DiscussionUpon completion of the trial, we will have 1) tested the effectiveness of two evidence-based decision aids in enhancing patients’ knowledge of options for prostate cancer therapy and 2) estimated whether decision aids may improve patient quality of life one year after initial treatment choice.Trial registrationClinicaltrials.gov: NCT03103321. The trial registration date (on ClinicalTrials.gov) was April 6, 2017.