New findings revealed that the highest mortality rates for prostate cancer among White male patients were found in the Western United States—including California—despite low incidence rates, according to a new study published by Schafer et al in European Urology. However, when compared with White male patients, Black male patients had approximately 70% to 110% higher incidence and mortality rates for prostate cancer overall across the United States. The new study also showed persistent sociodemographic disparities and unfavorable trends in incidence or mortality for all four major genitourinary cancers (bladder, kidney, prostate, and testicular) for male and female patients across the United States.
Background
“These data are a call to arms. Prostate cancer can be readily treated and eradicated when detected in early stage, yet this cancer type persists as the second leading cause of cancer death amongst [male patients] in the United States. Moreover, overall trends show a deeply concerning shift toward diagnosis of later stage disease. We can and must do more,” underscored senior study author Karen E. Knudsen, MBA, PhD, Chief Executive Officer of the American Cancer Society (ACS) and the ACS Cancer Action Network, highlighting that “This study reveals striking geographic and racial disparities that should be studied and mitigated. Our data identify a significant burden on a subset of populations, including [male patients] in the West and Black [male patients] overall. [The] ACS is committed to being part of the change, toward advancing prevention programs, early detection of disease, and better medical treatment and care for [patients with] prostate cancer.”
Study Methods and Findings
For this study, the investigators analyzed incidence rates for bladder, kidney, prostate, and testicular cancers in the United States from the Surveillance, Epidemiology, and End Results (SEER) Database at the National Cancer Institute; mortality rates from the U.S. Cancer Statistics database from the Center for Disease Control and Prevention (CDC); and data from the National Center for Health Statistics. The investigators examined cross-sectional and temporal trends in incidence and mortality rates—stratified by sex, race and ethnicity, and county—calculated age-adjusted incidence and mortality rates by the National Cancer Institute’s SEER Stat software, and analyzed temporal trends using the Joinpoint Regression Program.
The study results showed that incidence rates increased for kidney and testicular cancers and for advanced-stage prostate cancer in almost all racial and ethnic populations. Additionally, the investigators also reported that incidence and mortality rates for bladder and kidney cancers continued to be two to four times higher in male patients than in female patients.
Other key findings from the study included:
- The highest incidence rates among White individuals were found in the Northeast for bladder cancer and in the Appalachia region and parts of the South for kidney cancer.
- Incidence rates increased for bladder cancer among American Indian and Alaska Native individuals.
- Incidence rates increased for testicular cancer among all racial and ethnic groups, while mortality rates increased only among Hispanic male patients.
- Mortality rates stabilized for prostate cancer among White as well as Asian American and Pacific Islander male patients after a steady decline since the early 1990s.
Conclusions
“Previous studies have reported that differences in prevalence of cigarette smoking, obesity, and consumption of unhealthy [foods]—as well as inequity in receipt of standard of care—may have contributed to the disparities in incidence and mortality rates for some of the genitourinary cancers,” explained lead study author Elizabeth Schafer, MPH, an associate scientist II in Surveillance and Health Equity Science at the ACS. “However, further [investigation] is needed to better understand the causes of these disparities and help save lives.”
“The continued increase in both the incidence, and the percentage of [male individuals] presenting with regional- and advanced-disease prostate cancer is quite concerning,” stressed contributing study author William Dahut, MD, Chief Scientific Officer of the ACS, concluding that “Some of this can be explained by changes in screening patterns but the persistence of this finding suggests the possibility of a biologic or environmental factor.”
The investigators noted that further research may be needed to elucidate the reasons behind these patterns, to plan interventions preventing a greater rise in the burden of genitourinary cancers, and to mitigate the sociodemographic disparities recognized by the study.
Disclosure: For full disclosures of the study authors, visit europeanurology.com.
