Ming Wang1,2, Guangqing Chi3,4, Yosef Bodovski4, Sheldon L Holder5, Eugene J Lengerich1,2, Emily Wasserman1, Alicia C McDonald6,7,8. 1. Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA. 2. Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, 17033, USA. 3. Department of Agricultural Economics, Sociology and Education, Pennsylvania State University, University Park, PA, 16802, USA. 4. Computational and Spatial Analysis Core of the Social Science Research Institute and Population Research Institute, Pennsylvania State University, University Park, PA, 16802, USA. 5. Division of Hematology/Oncology Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, 17033, USA. 6. Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA. amcdonald3@phs.psu.edu. 7. Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, 17033, USA. amcdonald3@phs.psu.edu. 8. Pennsylvania State University College of Medicine, 500 University Drive, Mail Code CH69, Room T3412, P.O. Box 850, Hershey, PA, 17033-0850, USA. amcdonald3@phs.psu.edu.
Abstract
PURPOSE: Few studies have reported temporal and spatial trends of aggressive prostate cancer (PC) among black men who are known to have more aggressive disease. We examined these trends for highly aggressive PC at diagnosis among black and white men in Pennsylvania (PA). METHODS: Men, aged ≥ 40 years, with a primary, clinical PC diagnosis were identified from the Pennsylvania Cancer Registry, 2004-2014. Joinpoint analysis was used to evaluate the temporal trend of highly aggressive PC (clinical/pathologic Gleason score ≥ 7 [4 + 3], clinical/pathologic tumor stage ≥ T3, or distant metastasis) and identify change points by race in which annual percent change (APC) was calculated. Logistic regression analyses were used to examine the association between race and highly aggressive PC, after adjusting for covariates with and without spatial dependence. RESULTS: There were 89,133 PC cases, which included 88.7% white and 11.3% black men. The APC of highly aggressive PC was 8.7% from 2011 to 2014 among white men and 3.6% from 2007 to 2014 among black men (p values ≤ 0.01). The greatest odds of having highly aggressive PC among black compared to white men were found in counties where the black male population was ≤ 5.3%. CONCLUSIONS: Highly aggressive PC increased for both black and white men in PA between 2004 and 2014. Black men had more aggressive disease, with the greatest odds in counties where the black male population was small. The increase in highly aggressive PC may be due to less screening for PC, resulting in more advanced disease at diagnosis.
PURPOSE: Few studies have reported temporal and spatial trends of aggressive prostate cancer (PC) among black men who are known to have more aggressive disease. We examined these trends for highly aggressive PC at diagnosis among black and white men in Pennsylvania (PA). METHODS:Men, aged ≥ 40 years, with a primary, clinical PC diagnosis were identified from the Pennsylvania Cancer Registry, 2004-2014. Joinpoint analysis was used to evaluate the temporal trend of highly aggressive PC (clinical/pathologic Gleason score ≥ 7 [4 + 3], clinical/pathologic tumor stage ≥ T3, or distant metastasis) and identify change points by race in which annual percent change (APC) was calculated. Logistic regression analyses were used to examine the association between race and highly aggressive PC, after adjusting for covariates with and without spatial dependence. RESULTS: There were 89,133 PC cases, which included 88.7% white and 11.3% black men. The APC of highly aggressive PC was 8.7% from 2011 to 2014 among white men and 3.6% from 2007 to 2014 among black men (p values ≤ 0.01). The greatest odds of having highly aggressive PC among black compared to white men were found in counties where the black male population was ≤ 5.3%. CONCLUSIONS: Highly aggressive PC increased for both black and white men in PA between 2004 and 2014. Black men had more aggressive disease, with the greatest odds in counties where the black male population was small. The increase in highly aggressive PC may be due to less screening for PC, resulting in more advanced disease at diagnosis.
Entities:
Keywords:
Aggressiveness; Health disparities; Prostate cancer; Spatial analysis
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