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Risk Factors for Prostate Cancer Recurrence in African American Patients: VA versus Non-VA Healthcare Recipients

  • Author(s): Homayounpour, Pedram;
  • Advisor(s): Greenfield, Sheldon;
  • et al.

Biochemical recurrence (BCR) has been a cause of concern for patients and medical professionals. Although several studies have reported that only half of the patients with BCR eventually progress to metastatic disease at 10 years, there is a substantial need for developing a predictive pattern or algorithm to efficiently identify and categorize prostate cancer patients based on their risk of recurrence. Currently non-Hispanic African American adults experience the highest incidence and mortality rates for cancers, with prostate cancer being one of the most prevalent. These statistics could be significantly reduced by introducing an appropriate predictive mechanism by which patients with higher risk of recurrence and tumor progression could be identified and recommended for more aggressive treatments during initial diagnosis, preventing possible progression to metastasis. Recurrence and oncologic outcomes may be dependent on sociodemographic factors and certain other factors contributing to comorbidities. We selected the patients from Veterans Affairs medical facilities for a comparison group, primarily due to reports suggesting that VA patients provide a diverse group of individuals with different socioeconomic, educational, and medical backgrounds. VA patients are generally expected to present with clinically worse comorbidities. Ultimately, the aim was to demonstrate a significant association between higher SES and lowered risk of BCR in African American prostate cancer patients, adjusted for the site of care. We used ‘complexity’, Gleason, and Decipher scores to compare the differences in African American and White patients adjusting for site of care. Our results suggest that African American patients have higher complexity scores, which we defined as a dynamic state in which the personal, social, and clinical aspects of the patient's experience operate as complicating factors. African American patients also had higher Decipher scores regardless of site of care, suggesting a higher risk of BCR. Our findings indicate that complexity scores and Decipher scores can be simultaneously employed to assist in identifying patients with high risk of BCR, allowing for recommendations for intensive treatments.

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