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

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Abstract

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.

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Data Availability

The data that support the findings of this study are available from PCaP management team. Restrictions apply to the availability of these data.

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Acknowledgements

The authors thank the staff, advisory committees and research subjects participating in the PCaP study for their important contributions.

Funding

The North Carolina-Louisiana Prostate Cancer Project (PCaP) is carried out as a collaborative study supported by the Department of Defense contract DAMD 17-03-2-0052. SK is supported by the Foundation of Barnes-Jewish Hospital and Siteman Cancer Center.

Author information

Authors and Affiliations

  1. 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

    Saira Khan, Yunan Han & Siobhan Sutcliffe

  2. Epidemiology Program, College of Health Sciences, University of Delaware, 100 Discovery Blvd., 7th floor, Newark, DE, 19713, USA

    Saira Khan

  3. Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-COEE, Tampa, FL, 33612, USA

    Lindsay Fuzzell

  4. Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Marvin Langston

  5. 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

    Justin X. Moore

  6. 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

    Keon Gilbert

  7. Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, 4921 Parkview Place, St. Louis, MO, 63110, USA

    Siobhan Sutcliffe

  8. 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

    Jeannette T. Bensen

  9. Roswell Park Comprehensive Cancer Center, Elm and Carlton St, Buffalo, NY, 14263, USA

    James L. Mohler

  10. Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, USA

    Elizabeth T.H. Fontham

  11. School of Nursing, University of North Carolina - Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599, USA

    Lixin Song

  12. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr, Chicago, IL, 60611, USA

    Marquita W. Lewis-Thames

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  1. Saira Khan
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Contributions

SK: conceptualization, data curation, formal analysis, methodology, writing-original draft, writing-review and editing. LF: conceptualization, writing-original draft, writing-review and editing. ML: conceptualization, writing-original draft, writing-review and editing. YH: conceptualization, writing-original draft, writing-review and editing. JXM: conceptualization, writing-original draft, writing-review and editing. KG: conceptualization, writing-original draft, writing-review and editing. SS: methodology, writing-original draft, writing-review and editing. JTB: funding acquisition, project administration, resources, writing-review and editing. JLM: funding acquisition, resources, writing-review and editing. ETHF: funding acquisition, writing-review and editing. LS: conceptualization, project administration, writing-review and editing. MWL-T: conceptualization, writing-original draft, writing-review and editing.

Corresponding author

Correspondence to Saira Khan.

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Khan, S., Fuzzell, L., Langston, M. et al. The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer. Cancer Causes Control 35, 531–539 (2024). https://doi.org/10.1007/s10552-023-01821-9

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