The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer,Cancer Causes & Control

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The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer
Cancer Causes & Control ( IF 2.3 ) Pub Date : 2023-11-03 , DOI: 10.1007/s10552-023-01821-9
Saira Khan _{1,

2} , Lindsay Fuzzell ₃ , Marvin Langston ₄ , Yunan Han ₁ , Justin X Moore ₅ , Keon Gilbert ₆ , Siobhan Sutcliffe _{1,

7} , Jeannette T Bensen ₈ , James L Mohler ₉ , Elizabeth T H Fontham ₁₀ , Lixin Song ₁₁ , Marquita W Lewis-Thames ₁₂

Affiliation

Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA.
Epidemiology Program, College of Health Sciences, University of Delaware, 100 Discovery Blvd., 7th floor, Newark, DE, 19713, USA.
Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-COEE, Tampa, FL, 33612, USA.
Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
Center for Health Equity Transformation, Department of Behavioral Science, Department of Internal Medicine, Markey Cancer Center, University of Kentucky College of Medicine, 760 Press Avenue, Lexington, KY, 40536, USA.
Department of Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis, University, 3545 Lafayette Ave., Room 316, St. Louis, MO, 63103, USA.
Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, 4921 Parkview Place, St. Louis, MO, 63110, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, 3130 Bioinformatics Building, CB# 7295, Chapel Hill, NC, 27599, USA.
Roswell Park Comprehensive Cancer Center, Elm and Carlton St, Buffalo, NY, 14263, USA.
Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, USA.
School of Nursing, University of North Carolina - Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599, USA.
Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr, Chicago, IL, 60611, USA.

Purpose

To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort.

Methods

The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer.

Results

Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20–2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54–0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men.

Conclusion

Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.

中文翻译：

婚姻状况对诊断为前列腺癌的黑人和白人男性肿瘤侵袭性、治疗和筛查的影响

目的

在种族多样化的队列中检查婚姻状况与前列腺癌结果的关联。

方法

研究人群由基线北卡罗来纳州-路易斯安那州前列腺癌 (PCaP) 队列中患有前列腺癌的男性（1010 名黑人；1070 名白人）组成。诊断时的婚姻状况和筛查史由自我报告确定。婚姻状况的二元衡量标准被定义为已婚（包括已婚生活）与未婚（从未结婚、离婚/分居或丧偶）。高侵袭性肿瘤通过 PSA、格里森评分和分期的综合测量来定义。根治性治疗被定义为接受根治性前列腺切除术或放射治疗。使用多变量逻辑回归来检查婚姻状况与（1）高侵袭性肿瘤、（2）接受明确治疗和（3）患有前列腺癌的黑人和白人男性的筛查史之间的关系。

结果

黑人男性结婚的可能性低于白人男性（68.1% vs. 83.6%）。在整个研究人群中，未婚（相对于已婚）与高侵袭性肿瘤的几率增加相关（调整后的优势比 (aOR)：1.56；95% 置信区间 (CI)：1.20–2.02），无论黑人还是白人种族分层分析中的男性。在整个研究人群中，未婚男性接受明确治疗的可能性较小（aOR：0.68；95% CI：0.54-0.85）。在种族分层分析中，未婚黑人接受明确治疗的可能性较小。与已婚男性相比，未婚黑人和白人男性有前列腺癌筛查史的可能性较小。