Explaining the race difference in prostate cancer stage at diagnosis

Area of Science:

• Oncology
• Epidemiology
• Health Disparities

Background:

• Prostate cancer disproportionately affects Black males in the US, with higher incidence and mortality rates compared to White males.
• African-Americans are often diagnosed with prostate cancer at later, more advanced stages, impacting survival outcomes.
• Understanding the factors contributing to this race-stage disparity is crucial for developing targeted interventions.

Purpose of the Study:

• To investigate the clinical, sociodemographic, medical care, insurance, screening, and lifestyle factors contributing to the race-stage disparity in prostate cancer diagnosis.
• To assess the impact of these factors on long-term prostate cancer survival differences between racial groups.

Main Methods:

• A population-based case-case study involving 251 African-American and White prostate cancer patients diagnosed in Connecticut (1987-1990).
• Multivariate logistic regression was employed to identify explanatory factors for stage at diagnosis.
• Cox proportional hazards models were used to analyze race differences in long-term survival.

Main Results:

• Modifiable factors, including screening practices and sociodemographic characteristics, explained over 60% of the observed race difference in prostate cancer stage at diagnosis.
• Histologic grade (Gleason score) contributed less to the stage disparity.
• Tumor characteristics, education level, and insurance status were significant predictors of racial differences in survival.

Conclusions:

• Screening practices and sociodemographic factors play a substantial role in the advanced stage at diagnosis for Black men with prostate cancer.
• Addressing disparities in access to care, screening, and socioeconomic factors is essential to reduce racial inequalities in prostate cancer outcomes.
• Findings remain relevant for populations facing healthcare access challenges and screening disparities, even with the advent of PSA screening.