Highly aggressive prostate cancer at time of diagnosis increases in Pennsylvania

Among prostate cancer cases, highly aggressive cases of the disease at the time of diagnosis increased significantly in Pennsylvania between 2004 and 2014, according to Penn State College of Medicine and Penn State Cancer Institute researchers. The increase affected both white and black men, with black men having more highly aggressive prostate cancer at diagnosis. This rise could be because of less early screening resulting in more advanced stages of disease at diagnosis.

The researchers studied the change over time of prostate cancer rates and the geography of cases. To do this, they used the Pennsylvania Cancer Registry to review prostate cancer cases between 2004 and 2014. Researchers extracted address at the time of diagnosis, basic demographic information and clinical information about the cancer from the registry.

After analyzing the data, researchers determined:

• The proportion of highly aggressive prostate cancer increased from 2011 to 2014 for white men, and from 2007 to 2014 for black men.
• Black men had a higher proportion of aggressive disease compared to white men.
• Black men were younger at prostate cancer diagnosis and more likely to live in an urban area, compared to white men.
• The greatest odds of having highly aggressive prostate cancer in black men compared to white men were found in 10 counties where the black population is small. These counties are Tioga, Potter, Franklin, Fulton, Susquehanna, Venango, Mifflin, Erie, Wayne and Centre.

One possible reason for the overall higher rates of highly aggressive prostate cancer could be because the cancer is being detected at more advanced stages at diagnosis. The U.S. Preventative Services Task Force recommended against the use of prostate-specific antigen (PSA) screening for men 75 and older in 2008, and all men in 2012.

“The increase in highly aggressive prostate cancer starting in 2007 for black men and 2011 for white men may correspond to the prostate cancer screening recommendations,” researchers wrote in the paper, published in the journal Cancer Causes and Control.

Researchers offered possible reasons for the more significant association in the 10 Pennsylvania counties where black men had the greatest odds of having highly aggressive prostate cancer compared to white men with prostate cancer. White men in these counties may have lower rates of highly aggressive prostate cancer compared to black men. Another reason could be because of the relatively smaller black population in these counties. A third reason could be social and economic differences, including a lack of medical care, among black men compared to white men.

The majority of these counties are located in the Appalachian region of the state. The Appalachian population typically has a lower income, less access to medical care and lower high school graduation rates than compared to the rest of the United States.

“A study conducted in Appalachia Kentucky found that black men had poorer prostate cancer outcomes compared to their white counterparts, regardless of treatment and insurance status,” the researchers wrote. “There may be unknown or underlying factors related to health inequities that may explain prostate cancer disparities observed in these areas among black men.”

More research is needed to understand the reasons for the differences in highly aggressive prostate cancer rates and how the reasons differ by region of the state.

Researchers on this project were Ming Wang, PhD, associate professor of public health sciences; Guangquing Chi, PhD, associate professor of rural sociology and demography and public health sciences; Yosef Bodovski, GIA research analyst; Sheldon Holder, MD, PhD, assistant professor of medicine; Eugene Lengerich, VMD, professor of public health sciences; Emily Wasserman, research data analyst; and Alicia McDonald, PhD, assistant professor of public health sciences. Wang, Lengerich and McDonald are all members of Penn State Cancer Institute.

National Center for Advancing Translational Science through Penn State Clinical and Translational Science Institute, Eberly Medical Research Endowment Innovation Fund and Highmark Incorporation Grant at Penn State Cancer Institute funded this research.

Penn State Clinical and Translational Science Institute supports Lengerich, a member of the institute’s community-engaged research and network capacity cores. Wang is a former scholar in the institute’s Early-Stage Investigator Training Program (KL2).

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