Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors

Oluwarotimi S. Nettey, Austin J. Walker, Mary Kate Keeter, Ashima Singal, Aishwarya Nugooru, Iman K. Martin, Maria Ruden, Pooja Gogana, Michael A. Dixon, Tijani Osuma, Courtney M P Hollowell, Roohollah Sharifi, Marin Sekosan, Ximing J Yang, William J Catalona, Andre Kajdacsy-Balla, Virgilia Macias, Rick A. Kittles, Adam B Murphy*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction and Objective: Studies have linked Black race to prostate cancer (CaP) risk but most fail to account for established risk factors such as 5-ARI use, prostate volume, socioeconomic status, and hospital setting. We assess whether Black race remains associated with CaP and Gleason ≥3 + 4 CaP, after adjusting for clinical setting and socioeconomic and clinical factors at prostate biopsy, with a focus on men aged 40-54 years, who may be excluded from current screening guidelines. Methods: We recruited 564 men age 40-79 undergoing initial prostate biopsy for abnormal PSA or digital rectal examination (DRE) from three publicly funded and two private hospitals from 2009-2014. Univariate and multivariate analyses examined the associations between hospital type, race, West African Ancestry (WAA), clinical, and sociodemographic risk factors with CaP diagnosis and Gleason ≥3 + 4 CaP. Given changes in CaP screening recommendations, we also assess the multivariate analyses for men aged 40-54. Results: Black and White men had similar age, BMI, and prostate volume. Black men had higher PSA (8.10 ng/mL vs. 5.63 ng/mL) and PSA density (0.22 ng/mL/cm3 vs. 0.15 ng/mL/cm3, all p < 0.001). Blacks had higher frequency of CaP (63.1% vs. 41.5%, p<0.001) and Gleason ≥3+4 CaP relative to Whites in both public (27.7% vs 11.6%, p<0.001) and private (48.4% vs 21.6%, p = 0.002) settings. In models adjusted for age, first degree family history, prostate volume, 5-ARI use, hospital type, income, marital and educational status, Black race was independently associated with overall CaP diagnosis (OR = 2.13, p = 0.002). There was a significant multiplicative interaction with Black race and abnormal DRE for Gleason ≥3 + 4 CaP (OR = 2.93, p = 0.01). WAA was not predictive of overall or significant CaP among Black men. Black race (OR = 5.66, p = 0.02) and family history (OR = 4.98, p = 0.01) were independently positively associated with overall CaP diagnosis for men aged 40 to 54. Conclusions: Black race is independently associated with CaP and Gleason ≥3+4 CaP after accounting for clinical and socioeconomic risk factors including clinical setting and WAA, and has a higher odds ratio of CaP diagnosis in younger men. Further investigation into optimizing screening in Black men aged 40 to 54 is warranted.

Original languageEnglish (US)
Pages (from-to)501.e1-501.e8
JournalUrologic Oncology: Seminars and Original Investigations
Volume36
Issue number11
DOIs
StatePublished - Nov 1 2018

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Prostatic Neoplasms
Prostate
Digital Rectal Examination
Multivariate Analysis
Biopsy
Private Hospitals
Educational Status
Marital Status
Social Class
Odds Ratio
Guidelines

Keywords

  • African Americans
  • Biopsy outcomes
  • Cancer disparities
  • Prostate cancer
  • Socioeconomics

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Nettey, Oluwarotimi S. ; Walker, Austin J. ; Keeter, Mary Kate ; Singal, Ashima ; Nugooru, Aishwarya ; Martin, Iman K. ; Ruden, Maria ; Gogana, Pooja ; Dixon, Michael A. ; Osuma, Tijani ; Hollowell, Courtney M P ; Sharifi, Roohollah ; Sekosan, Marin ; Yang, Ximing J ; Catalona, William J ; Kajdacsy-Balla, Andre ; Macias, Virgilia ; Kittles, Rick A. ; Murphy, Adam B. / Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors. In: Urologic Oncology: Seminars and Original Investigations. 2018 ; Vol. 36, No. 11. pp. 501.e1-501.e8.
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title = "Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors",
abstract = "Introduction and Objective: Studies have linked Black race to prostate cancer (CaP) risk but most fail to account for established risk factors such as 5-ARI use, prostate volume, socioeconomic status, and hospital setting. We assess whether Black race remains associated with CaP and Gleason ≥3 + 4 CaP, after adjusting for clinical setting and socioeconomic and clinical factors at prostate biopsy, with a focus on men aged 40-54 years, who may be excluded from current screening guidelines. Methods: We recruited 564 men age 40-79 undergoing initial prostate biopsy for abnormal PSA or digital rectal examination (DRE) from three publicly funded and two private hospitals from 2009-2014. Univariate and multivariate analyses examined the associations between hospital type, race, West African Ancestry (WAA), clinical, and sociodemographic risk factors with CaP diagnosis and Gleason ≥3 + 4 CaP. Given changes in CaP screening recommendations, we also assess the multivariate analyses for men aged 40-54. Results: Black and White men had similar age, BMI, and prostate volume. Black men had higher PSA (8.10 ng/mL vs. 5.63 ng/mL) and PSA density (0.22 ng/mL/cm3 vs. 0.15 ng/mL/cm3, all p < 0.001). Blacks had higher frequency of CaP (63.1{\%} vs. 41.5{\%}, p<0.001) and Gleason ≥3+4 CaP relative to Whites in both public (27.7{\%} vs 11.6{\%}, p<0.001) and private (48.4{\%} vs 21.6{\%}, p = 0.002) settings. In models adjusted for age, first degree family history, prostate volume, 5-ARI use, hospital type, income, marital and educational status, Black race was independently associated with overall CaP diagnosis (OR = 2.13, p = 0.002). There was a significant multiplicative interaction with Black race and abnormal DRE for Gleason ≥3 + 4 CaP (OR = 2.93, p = 0.01). WAA was not predictive of overall or significant CaP among Black men. Black race (OR = 5.66, p = 0.02) and family history (OR = 4.98, p = 0.01) were independently positively associated with overall CaP diagnosis for men aged 40 to 54. Conclusions: Black race is independently associated with CaP and Gleason ≥3+4 CaP after accounting for clinical and socioeconomic risk factors including clinical setting and WAA, and has a higher odds ratio of CaP diagnosis in younger men. Further investigation into optimizing screening in Black men aged 40 to 54 is warranted.",
keywords = "African Americans, Biopsy outcomes, Cancer disparities, Prostate cancer, Socioeconomics",
author = "Nettey, {Oluwarotimi S.} and Walker, {Austin J.} and Keeter, {Mary Kate} and Ashima Singal and Aishwarya Nugooru and Martin, {Iman K.} and Maria Ruden and Pooja Gogana and Dixon, {Michael A.} and Tijani Osuma and Hollowell, {Courtney M P} and Roohollah Sharifi and Marin Sekosan and Yang, {Ximing J} and Catalona, {William J} and Andre Kajdacsy-Balla and Virgilia Macias and Kittles, {Rick A.} and Murphy, {Adam B}",
year = "2018",
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language = "English (US)",
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Nettey, OS, Walker, AJ, Keeter, MK, Singal, A, Nugooru, A, Martin, IK, Ruden, M, Gogana, P, Dixon, MA, Osuma, T, Hollowell, CMP, Sharifi, R, Sekosan, M, Yang, XJ, Catalona, WJ, Kajdacsy-Balla, A, Macias, V, Kittles, RA & Murphy, AB 2018, 'Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors', Urologic Oncology: Seminars and Original Investigations, vol. 36, no. 11, pp. 501.e1-501.e8. https://doi.org/10.1016/j.urolonc.2018.06.011

Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors. / Nettey, Oluwarotimi S.; Walker, Austin J.; Keeter, Mary Kate; Singal, Ashima; Nugooru, Aishwarya; Martin, Iman K.; Ruden, Maria; Gogana, Pooja; Dixon, Michael A.; Osuma, Tijani; Hollowell, Courtney M P; Sharifi, Roohollah; Sekosan, Marin; Yang, Ximing J; Catalona, William J; Kajdacsy-Balla, Andre; Macias, Virgilia; Kittles, Rick A.; Murphy, Adam B.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 36, No. 11, 01.11.2018, p. 501.e1-501.e8.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors

AU - Nettey, Oluwarotimi S.

AU - Walker, Austin J.

AU - Keeter, Mary Kate

AU - Singal, Ashima

AU - Nugooru, Aishwarya

AU - Martin, Iman K.

AU - Ruden, Maria

AU - Gogana, Pooja

AU - Dixon, Michael A.

AU - Osuma, Tijani

AU - Hollowell, Courtney M P

AU - Sharifi, Roohollah

AU - Sekosan, Marin

AU - Yang, Ximing J

AU - Catalona, William J

AU - Kajdacsy-Balla, Andre

AU - Macias, Virgilia

AU - Kittles, Rick A.

AU - Murphy, Adam B

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Introduction and Objective: Studies have linked Black race to prostate cancer (CaP) risk but most fail to account for established risk factors such as 5-ARI use, prostate volume, socioeconomic status, and hospital setting. We assess whether Black race remains associated with CaP and Gleason ≥3 + 4 CaP, after adjusting for clinical setting and socioeconomic and clinical factors at prostate biopsy, with a focus on men aged 40-54 years, who may be excluded from current screening guidelines. Methods: We recruited 564 men age 40-79 undergoing initial prostate biopsy for abnormal PSA or digital rectal examination (DRE) from three publicly funded and two private hospitals from 2009-2014. Univariate and multivariate analyses examined the associations between hospital type, race, West African Ancestry (WAA), clinical, and sociodemographic risk factors with CaP diagnosis and Gleason ≥3 + 4 CaP. Given changes in CaP screening recommendations, we also assess the multivariate analyses for men aged 40-54. Results: Black and White men had similar age, BMI, and prostate volume. Black men had higher PSA (8.10 ng/mL vs. 5.63 ng/mL) and PSA density (0.22 ng/mL/cm3 vs. 0.15 ng/mL/cm3, all p < 0.001). Blacks had higher frequency of CaP (63.1% vs. 41.5%, p<0.001) and Gleason ≥3+4 CaP relative to Whites in both public (27.7% vs 11.6%, p<0.001) and private (48.4% vs 21.6%, p = 0.002) settings. In models adjusted for age, first degree family history, prostate volume, 5-ARI use, hospital type, income, marital and educational status, Black race was independently associated with overall CaP diagnosis (OR = 2.13, p = 0.002). There was a significant multiplicative interaction with Black race and abnormal DRE for Gleason ≥3 + 4 CaP (OR = 2.93, p = 0.01). WAA was not predictive of overall or significant CaP among Black men. Black race (OR = 5.66, p = 0.02) and family history (OR = 4.98, p = 0.01) were independently positively associated with overall CaP diagnosis for men aged 40 to 54. Conclusions: Black race is independently associated with CaP and Gleason ≥3+4 CaP after accounting for clinical and socioeconomic risk factors including clinical setting and WAA, and has a higher odds ratio of CaP diagnosis in younger men. Further investigation into optimizing screening in Black men aged 40 to 54 is warranted.

AB - Introduction and Objective: Studies have linked Black race to prostate cancer (CaP) risk but most fail to account for established risk factors such as 5-ARI use, prostate volume, socioeconomic status, and hospital setting. We assess whether Black race remains associated with CaP and Gleason ≥3 + 4 CaP, after adjusting for clinical setting and socioeconomic and clinical factors at prostate biopsy, with a focus on men aged 40-54 years, who may be excluded from current screening guidelines. Methods: We recruited 564 men age 40-79 undergoing initial prostate biopsy for abnormal PSA or digital rectal examination (DRE) from three publicly funded and two private hospitals from 2009-2014. Univariate and multivariate analyses examined the associations between hospital type, race, West African Ancestry (WAA), clinical, and sociodemographic risk factors with CaP diagnosis and Gleason ≥3 + 4 CaP. Given changes in CaP screening recommendations, we also assess the multivariate analyses for men aged 40-54. Results: Black and White men had similar age, BMI, and prostate volume. Black men had higher PSA (8.10 ng/mL vs. 5.63 ng/mL) and PSA density (0.22 ng/mL/cm3 vs. 0.15 ng/mL/cm3, all p < 0.001). Blacks had higher frequency of CaP (63.1% vs. 41.5%, p<0.001) and Gleason ≥3+4 CaP relative to Whites in both public (27.7% vs 11.6%, p<0.001) and private (48.4% vs 21.6%, p = 0.002) settings. In models adjusted for age, first degree family history, prostate volume, 5-ARI use, hospital type, income, marital and educational status, Black race was independently associated with overall CaP diagnosis (OR = 2.13, p = 0.002). There was a significant multiplicative interaction with Black race and abnormal DRE for Gleason ≥3 + 4 CaP (OR = 2.93, p = 0.01). WAA was not predictive of overall or significant CaP among Black men. Black race (OR = 5.66, p = 0.02) and family history (OR = 4.98, p = 0.01) were independently positively associated with overall CaP diagnosis for men aged 40 to 54. Conclusions: Black race is independently associated with CaP and Gleason ≥3+4 CaP after accounting for clinical and socioeconomic risk factors including clinical setting and WAA, and has a higher odds ratio of CaP diagnosis in younger men. Further investigation into optimizing screening in Black men aged 40 to 54 is warranted.

KW - African Americans

KW - Biopsy outcomes

KW - Cancer disparities

KW - Prostate cancer

KW - Socioeconomics

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DO - 10.1016/j.urolonc.2018.06.011

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