Racial Disparities in Prostate Cancer: Prostate-Cancer Specific Mortality Across Grade Groups in African American vs White Men, 2010-2020: A SEER Analysis Restricted; Files Only
Polacek, Natalie (Summer 2024)
Abstract
Background: Prostate cancer is one of the most common cancer types among American men, and prostate cancer specific mortality (PCSM) rates are almost double in African American compared to White men. While racial disparities in PCSM have been narrowing over time, prior studies have shown that African Americans have a higher risk of prostate cancer death compared to White men among those diagnosed with low-risk disease. The objective of this study was to build off prior research to determine whether the risk of PCSM differs by race for each of the five clinical grade groups.
Methods: A retrospective cohort analysis was performed on de-identified data from 289,521 males diagnosed with prostate cancer from 2010–2020 in the Surveillance, Epidemiology, and End Results (SEER) database. Fine-Gray competing risks regression models were built to analyze the effect of race, grade group, and a race x grade group interaction term on PCSM after adjusting for prognostic and sociodemographic covariates. Subdistribution hazard ratios and 95% confidence intervals were defined for the primary exposures and predictors.
Results: After a median follow-up of 57 months, 5,170 males (975 [1.86% of] African American and 4,195 [1.77% of] White men), died from prostate cancer. The Fine-Gray competing risks regression with the race x grade group interaction term found a statistically significant difference in PCSM among certain grade groups. In grade groups 1 and 2, African American men had a significantly higher risk of PCSM compared to White men (1: FG HR 1.60, 95% CI [1.32, 1.94]; 2: FG HR 1.21, 95% CI [1.02, 1.45]). In grade groups 3 and 4, no significant difference in PCSM was observed between African American and White men (3: FG HR 1.04, 95% CI [0.87, 1.25]); 4: (FG HR 0.95, 95% CI [0.82, 1.10]). In grade group 5, African American men had a significantly lower risk of PCSM compared to White men (FG HR 0.85, 95% CI [0.75, 0.97]). All covariates were significantly associated with PCSM.
Conclusion: African American men were associated with a higher risk of PCSM compared to White men among those diagnosed with low-risk prostate cancer (i.e., grade groups 1 and 2). This finding is consistent with the previous literature and demonstrates the need to further study and characterize African American men with low-risk prostate cancer to reduce disparities in PCSM.
Table of Contents
Section 1: Introduction
Problem Statement
Thesis Purpose
Section 2: Background Literature Review
Overview
Prostate-Specific Antigen Screening
Prostate Cancer Grading (Gleason Score & Grade Group)
Prostate Cancer Treatment Options
Racial Disparities in Prostate Cancer
Section 3: Study Design & Methods
Data Source
Study Population
Outcomes
Exposure
Covariates
Statistical Analysis
Section 4: Results
Study Population
Cumulative Incidence Estimates of PCSM
Model Assessment
Risk Factors Associated with PCSM
Risk Factors Associated with Non-PCSM
Section 5: Discussion
Strengths
Limitations
Conclusion & Recommendations
Figures and Tables
References
About this Master's Thesis
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File download under embargo until 16 August 2025 | 2024-07-25 16:59:37 -0400 | File download under embargo until 16 August 2025 |
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