br Figure Scatterplot of Postsurgical
Figure 2 Scatterplot of Postsurgical Cancer of the Prostate Risk Assessment (CAPRA-S) Scores According to Income Level for Each Individual Patient; an Inverse Association Is Shown
Despite limited understanding of the mechanisms through which low SES increases the risk of adverse prostate cancers, there are clinical implications that can be gleaned from the current data. Our findings suggest that public health efforts to promote prostate cancer awareness and encourage prostate cancer screening might be especially beneficial in impoverished communities. Furthermore, tumors diagnosed in low SES individuals might be better managed with early, aggressive intervention as opposed to more conservative treatment modalities.
A primary limitation of our analysis is the use of census tract data as an estimate of median household income. Although previous studies have shown census tract data to correlate reasonably well with patient SES,8-10 census tract estimates are only a surrogate measure of individual household income. Furthermore, non-socioeconomic factors specific to a census tract could potentially influence prostate cancer severity. For example, a geographically isolated census tract with a paucity of health care facilities could result in more difficult access to care, delayed presentation of dis-ease, and inferior prostate cancer outcomes. As such, our findings linking low SES to adverse prostate cancer outcomes in AA men should be considered hypothesis-generating, and additional work is needed to confirm these findings.
Additional limitations include that we were unable to account for the effect of education level on the outcomes of interest. Low ed-ucation levels are common among men from socioeconomically disadvantaged neighborhoods and this lack of education likely works in concert with SES in predisposing patients to adverse prostate cancer outcomes.21,26 Because SES and education level are closely correlated, future study is needed to define the independent contribution of each of these factors in determining cancer-specific outcomes. Finally, this study used pathological outcomes as a proxy for the measurement of prostate cancer-specific mortality and longer follow-up is necessary before mortality data will be available in this cohort.
In the current study, we showed low SES to be an independent predictor of adverse prostate cancer pathology in a Z-VAD-FMK of AA men treated with RP for clinically localized prostate cancer. By
Clinical Genitourinary Cancer Month 2019 - 5
Poverty and Adverse Prostate Cancer Pathology
using a study design that included patients within a single racial demographic ethnicity, the confounding effects of race on prostate cancer risk were eliminated. These data suggest that impoverished men might be more likely to benefit from early prostate cancer detection and treatment. Community outreach, education, and screening efforts should therefore target low-income men for early intervention.
Clinical Practice Points
African American men are disproportionately affected by aggressive prostate cancer.
We retrospectively reviewed data from 2 institutions for AA men who underwent RP and tested for associations between SES and adverse prostate cancer pathology after RP.
Men of low SES had significantly higher PSA values and CAPRA-S scores, more advanced pathologic stage, and higher rates of SVI, positive surgical margins, and adverse pathology. These findings suggest that impoverished populations might benefit from more intensive screening and early, aggressive treatment of prostatic malignancies.
The authors have stated that they have no conflicts of interest.
3. Porten SP, Richardson DA, Odisho AY, McAninch JW, Carroll PR, Cooperberg MR. Disproportionate presentation of high risk prostate cancer in a safety net health system. J Urol 2010; 184:1931-6.
4. Du XL, Fang S, Coker AL, et al. Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer 2006; 106:1276-85. 5. Klein J, von dem Knesebeck O. Socioeconomic inequalities in prostate cancer survival: a review of the evidence and explanatory factors. Soc Sci Med 2015; 142:9-18. 6. RobbinsAS, WhittemoreAS,ThomDH.Differencesinsocioeconomicstatusandsurvival among white and black men with prostate cancer. Am J Epidemiol 2000; 151:409-16.
7. Cheng I, Witte JS, McClure LA, et al. Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California. Cancer Causes Control 2009; 20:1431-40.