Program Director/Principal Investigator (Last, First, Middle): Rebbeck, T i m o t h y R Project 1 PROJECT SUMMARY (See instructions): Prostate cancer is a common, complex disease with strong ethnic disparities and only a few confirmed and non-modifiable risk factors. African-Americans are at highest risk for developing prostate cancer and often present with advanced disease. Obesity, a potentially modifiable risk factor, has been shown to increase the risk of advanced disease at diagnosis and treatment (biochemical) failure. Obesity is also most prevalent in African-American populations. However, there has been controversy regarding obesity's role in prostate cancer progression, as all studies have not shown associations. Although linked to obesity and advanced cancer, patient- and neighborhood-level factors have not been studied as modifiers of obesity effects in prostate cancer patients. The goal of this project is to examine prostate cancer disparities and to build multilevel models of obesity and prostate cancer outcomes. Our general hypothesis is that patient- and neighborhood-level factors that often differ by race/ethnicity modify the effects of obesity on prostate cancer outcomes. We propose the following specific aims:
Aim 1 : To determine associations between racial disparities (measured by the relative measure of disparity. Slope Index of Inequality, and the Relative Index of Inequality mean and ratio) in prostate cancer severity (Kattan Scores, tumor characteristics, and age at diagnosis) and demographic/behavioral modifiers (body mass index (BMI), pack years, years of education, and age);
Aim 2 : To determine the relationship between obesity and prostate cancer outcomes by neighborhood characteristics (socioeconomic status, stress, demographic composition, and built environment). We will use a prospective, longitudinal case-case study design to examine the relationship between patient- and neighborhood-level characteristics and disparities in prostate cancer severity. These outcomes include pathological factors, age at diagnosis, tumor stage at diagnosis, PSA at diagnosis, and risk of treatment failure. Measures of disparity will be used to determine how racial disparities vary with obesity, smoking, education and age. Multivariate models will be used to examine the effects of obesity on prostate cancer outcomes, determining the influence of patient and neighborhood factors. We will be able to distinguish the effects of obesity from other patient-level variables and to examine such effects in neighborhood context. Determining significant modification by patient and neighborhood variables may suggest novel pathways for prostate cancer progression, identify groups of patients at highest risk for poor outcomes, and provide strategies for effective intervention to decrease disparities.

Public Health Relevance

Obesity is a major public health problem that has implications for many diseases, including prostate cancer. We will study the role of obesity and factors correlated with obesity on prostate cancer outcomes. This research will help to identify potentially modifiable factors associated with prostate cancer disparities.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Comprehensive Center (P60)
Project #
1P60MD006900-01
Application #
8352627
Study Section
Special Emphasis Panel (ZMD1-RN (02))
Project Start
2012-08-27
Project End
2017-02-28
Budget Start
2012-08-27
Budget End
2013-02-28
Support Year
1
Fiscal Year
2012
Total Cost
$195,218
Indirect Cost
$70,333
Name
University of Pennsylvania
Department
Type
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Wong, Michelle S; Grande, David T; Mitra, Nandita et al. (2017) Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems. Med Care 55:817-822
Rebbeck, Timothy R (2017) Prostate Cancer Genetics: Variation by Race, Ethnicity, and Geography. Semin Radiat Oncol 27:3-10
Jiang, Tammy; Stillson, Christian H; Pollack, Craig Evan et al. (2017) How Men with Prostate Cancer Choose Specialists: A Qualitative Study. J Am Board Fam Med 30:220-229
Radhakrishnan, Archana; Grande, David; Mitra, Nandita et al. (2017) Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment. Cancer 123:1027-1034
Lynch, Shannon M; Mitra, Nandita; Ravichandran, Krithika et al. (2017) Telomere Length and Neighborhood Circumstances: Evaluating Biological Response to Unfavorable Exposures. Cancer Epidemiol Biomarkers Prev 26:553-560
Pollack, Craig Evan; Armstrong, Katrina A; Mitra, Nandita et al. (2017) A multidimensional view of racial differences in access to prostate cancer care. Cancer 123:4449-4457
Radhakrishnan, Archana; Grande, David; Ross, Michelle et al. (2017) When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. J Am Board Fam Med 30:298-307
Yamoah, Kosj; Zeigler-Johnson, Charnita M; Jeffers, Abra et al. (2016) The impact of body mass index on treatment outcomes for patients with low-intermediate risk prostate cancer. BMC Cancer 16:557
Yamoah, Kosj; Deville, Curtiland; Vapiwala, Neha et al. (2015) African American men with low-grade prostate cancer have increased disease recurrence after prostatectomy compared with Caucasian men. Urol Oncol 33:70.e15-22
Zeigler-Johnson, Charnita; Morales, Knashawn H; Glanz, Karen et al. (2015) Individual- and neighborhood-level education influences the effect of obesity on prostate cancer treatment failure after prostatectomy. Cancer Causes Control 26:1329-37

Showing the most recent 10 out of 14 publications