Studies show prostate cancer outcomes may depend on where patients live in Pennsylvania
The American Cancer Society estimates that Pennsylvania doctors will diagnose 11,160 new cases of prostate cancer this year. Researchers from Penn State College of Medicine and Penn State Cancer Institute conducted two studies that show how where patients live may affect their risks for developing and surviving prostate cancer.
In the first study, investigators analyzed geographical locations such as country of residence at time of diagnosis and risk factors associated with higher mortality rates of prostate cancer. Within the areas studied, they determined that certain regions had higher concentrated cases of prostate cancer than others.
Investigators reviewed statewide prostate cancer mortality rates and compared that data to rates in counties surrounding Penn State Cancer Institute. The catchment area consisted of 28 counties and roughly one third of the state’s population. Researchers found that spatial variations in mortality rates exist in Pennsylvania, and that patients in the catchment area had a higher risk of dying from prostate cancer.
Researchers examined data from 94,274 prostate cancer patients, aged 40 and older. All of the men had biopsies and clinical indications of prostate cancer. Researchers used the 2018 County Health Rankings and the 2014 U.S. Environmental Protection Agency’s Environmental Quality Index to extract county-level data.
The researchers found that statewide prostate cancer mortality rates are decreasing. Investigators found that the 5-year survival rate in Pennsylvania was 82%. However, men living in rural and Appalachian areas are at a higher risk for adverse outcomes. Within the study’s catchment area, patients had more advanced stages of prostate cancer and survival rates were lower in rural Appalachian regions. The researchers said that certain health and environmental factors contributed to a higher number of deaths. Counties with high levels of air pollution and chemical pesticides had lower survival rates.
For the second study, Penn State researchers revisited data from the 2004–2014 Pennsylvania Cancer Registry to compare prostate cancer rates in Appalachia with non-Appalachia areas. To better understand geographic disparities, they examined the association between these regions and incidences of advanced prostate cancer at diagnosis.
The report, Prostate Cancer Incidence and Aggressiveness in Appalachia versus Non-Appalachia Populations in Pennsylvania by Urban-Rural Regions, 2004–2014, analyzes data from 94,274 patients. The researchers found that men living in the state’s urban areas have an increased risk of prostate cancer, and that urban non-Appalachia areas had the highest rates of prostate cancer. By comparison, men living in rural Appalachia had the lowest rates of the disease. Among prostate cancer cases, men in urban Appalachia areas were more likely to have a more aggressive form of prostate cancer at diagnosis compared to those living in urban non-Appalachia areas.
Addressing the disparities and improving access to information and cancer screenings could improve outcomes for prostate cancer patients living throughout these regions.
Ming Wang, Alicia McDonald, Lijun Zhang, Raymond Hohl, Eugene Lengerich, Emily Wasserman, Nathaniel Geyer and Jay Raman of Penn State College of Medicine; Shanshan Zhao of the National Institute of Environmental Health Sciences; and Rachel Carroll of the University of North Carolina at Wilmington contributed to this research.
This research was supported by the National Institutes of Health (NIH), the Highmark Incorporation Grant at Penn State Cancer Institute, the National Institute of Environmental Health Sciences, the Eberly Medical Research Endowment Innovation Fund at Penn State College of Medicine and a pilot grant from the National Center for Advancing Translational Sciences through a pilot grant from Penn State Clinical and Translational Science Institute, (Grant number, UL1 TR002014) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or other funders.
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