High-Risk Prostate Cancer Linked to Poverty
In a study of African-American radical prostatectomy patients, low income predicted a higher risk of advanced stage or aggressive tumors.
SAN DIEGO—Poverty is associated with an increased risk of advanced stage or aggressive prostate cancer (PCa), regardless of race, investigators reported at the American Urological Association's 2016 annual meeting.
“Among African American men with prostate cancer, poverty appears to increase the likelihood of high-risk disease,” lead researcher Adam Reese, MD, chief of urologic oncology at Temple University School of Medicine in Philadelphia, told Renal & Urology News. “Impoverished men may be more likely to benefit from intensive prostate cancer screening and early, aggressive treatment.”
Dr. Reese and his colleagues studied 389 African-American PCa patients who underwent radical prostatectomy. The median household income for the cohort was $40,031 (range $14,297–$162,615). The researchers divided subjects into low- and high-income groups (below and above the median income, respectively). Adverse pathology—defined as Gleason 3+4 disease, stage pT3 or higher tumors, or lymph node involvement—was found in 40.6% of the low-income group versus 29.1% of the high-income groups, a significant difference between the groups. Significantly greater proportions of patients in the low-income group than the high-income group had seminal vesicle invasion (17.3% vs. 8.4%), positive surgical margins (35.2% vs. 22.4%), intermediate-risk cancer (38.2% vs. 23.6%), and high-risk cancer (18.8% vs. 13.0%).
In addition, low-income patients had higher PSA levels. For example, 17.0% and 10.1% of low-income patients had PSA levels of 10–20 and higher than 20 ng/mL, respectively, compared with 12.2% and 3.2% of high-income patients, respectively.
“Community outreach, education, and screening efforts should target low-income men to decrease prostate cancer morbidity,” the authors concluded in their study abstract.