PURPOSE: The proportion of American men with organ confined, low risk prostate cancer has increased significantly during the last 2 decades. Whether this trend also applies to men at the extremes of socioeconomic disadvantage remains unknown. Therefore, we evaluated trends in prostate cancer severity in an ethnically diverse cohort of low income, uninsured men served by a state funded public health program in California. MATERIALS AND METHODS: We performed a retrospective cohort study of 570 disadvantaged men enrolled in the California program from 2001 through 2006. Using routinely collected clinical variables we defined 2 measures of cancer severity as 1) the proportion of enrollees with metastases at diagnosis and 2) the proportions of men with nonmetastatic tumors whose cancers had low, intermediate or high risk features at diagnosis. We performed bivariate analyses to assess time trends in cancer severity. RESULTS: Prostate specific antigen levels at diagnosis exceeded 10 ng/ml for 51% of enrollees, 50% had a Gleason score 7 or greater and 43% had clinical T stage T2 or greater. Of disadvantaged men 19% had metastatic cancer at diagnosis and this proportion remained stable over time (p = 0.66). Among men with nonmetastatic cancers 24% had tumors with low risk features and the proportion of low risk cancers did not increase over time (p = 0.34). CONCLUSIONS: Unlike the broader United States population the proportion of disadvantaged men with organ confined, low risk prostate cancer has not been increasing. Thus, while much attention focuses on potential overdiagnosis and overtreatment of men with screen detected prostate cancer, our findings suggest that for low income, uninsured men, underdetection and undertreatment remain significant concerns.
PURPOSE: The proportion of American men with organ confined, low risk prostate cancer has increased significantly during the last 2 decades. Whether this trend also applies to men at the extremes of socioeconomic disadvantage remains unknown. Therefore, we evaluated trends in prostate cancer severity in an ethnically diverse cohort of low income, uninsured men served by a state funded public health program in California. MATERIALS AND METHODS: We performed a retrospective cohort study of 570 disadvantaged men enrolled in the California program from 2001 through 2006. Using routinely collected clinical variables we defined 2 measures of cancer severity as 1) the proportion of enrollees with metastases at diagnosis and 2) the proportions of men with nonmetastatic tumors whose cancers had low, intermediate or high risk features at diagnosis. We performed bivariate analyses to assess time trends in cancer severity. RESULTS:Prostate specific antigen levels at diagnosis exceeded 10 ng/ml for 51% of enrollees, 50% had a Gleason score 7 or greater and 43% had clinical T stage T2 or greater. Of disadvantaged men 19% had metastatic cancer at diagnosis and this proportion remained stable over time (p = 0.66). Among men with nonmetastatic cancers 24% had tumors with low risk features and the proportion of low risk cancers did not increase over time (p = 0.34). CONCLUSIONS: Unlike the broader United States population the proportion of disadvantaged men with organ confined, low risk prostate cancer has not been increasing. Thus, while much attention focuses on potential overdiagnosis and overtreatment of men with screen detected prostate cancer, our findings suggest that for low income, uninsured men, underdetection and undertreatment remain significant concerns.
Authors: Gerald L Andriole; David L Levin; E David Crawford; Edward P Gelmann; Paul F Pinsky; David Chia; Barnett S Kramer; Douglas Reding; Timothy R Church; Robert L Grubb; Grant Izmirlian; Lawrence R Ragard; Jonathan D Clapp; Philip C Prorok; John K Gohagan Journal: J Natl Cancer Inst Date: 2005-03-16 Impact factor: 13.506
Authors: Ruth Etzioni; David F Penson; Julie M Legler; Dante di Tommaso; Rob Boer; Peter H Gann; Eric J Feuer Journal: J Natl Cancer Inst Date: 2002-07-03 Impact factor: 13.506
Authors: David C Miller; Lillian Gelberg; Lorna Kwan; Sevan Stepanian; Arlene Fink; Ronald M Andersen; Mark S Litwin Journal: J Community Health Date: 2008-10
Authors: A V D'Amico; R Whittington; S B Malkowicz; D Schultz; K Blank; G A Broderick; J E Tomaszewski; A A Renshaw; I Kaplan; C J Beard; A Wein Journal: JAMA Date: 1998-09-16 Impact factor: 56.272
Authors: David K Espey; Xiao-Cheng Wu; Judith Swan; Charles Wiggins; Melissa A Jim; Elizabeth Ward; Phyllis A Wingo; Holly L Howe; Lynn A G Ries; Barry A Miller; Ahmedin Jemal; Faruque Ahmed; Nathaniel Cobb; Judith S Kaur; Brenda K Edwards Journal: Cancer Date: 2007-11-15 Impact factor: 6.860
Authors: Matthew R Cooperberg; Deborah P Lubeck; Maxwell V Meng; Shilpa S Mehta; Peter R Carroll Journal: J Clin Oncol Date: 2004-06-01 Impact factor: 44.544
Authors: Sean F Altekruse; Lan Huang; James E Cucinelli; Timothy S McNeel; Kristen M Wells; M Norman Oliver Journal: Cancer Epidemiol Biomarkers Prev Date: 2010-05-25 Impact factor: 4.254
Authors: Omotola S Ashorobi; Jacqueline Frost; Xuemei Wang; Pamela Roberson; E Lin; Robert J Volk; David S Lopez; Lovell A Jones; Curtis A Pettaway Journal: Am J Mens Health Date: 2016-07-08
Authors: M Kongnyuy; M M Siddiqui; A K George; A Muthigi; A Sidana; M Maruf; B Turkbey; P L Choyke; B J Wood; P A Pinto Journal: Prostate Cancer Prostatic Dis Date: 2017-04-25 Impact factor: 5.554
Authors: Stacy Loeb; Marc A Bjurlin; Joseph Nicholson; Teuvo L Tammela; David F Penson; H Ballentine Carter; Peter Carroll; Ruth Etzioni Journal: Eur Urol Date: 2014-01-09 Impact factor: 20.096
Authors: Karim Chamie; Sarah E Connor; Sally L Maliski; Arlene Fink; Lorna Kwan; Mark S Litwin Journal: Urol Oncol Date: 2011-11-27 Impact factor: 3.498