Prostate cancer (PCa) is the most common non-cutaneous malignancy in US men and the second cause of cancer death, with age-adjusted mortality of 62.3 per 100,000 in African American (AA) and 25.6 per 100,000 in European American (EA) men. Although the high mortality from PCa represents a critical public health problem, our understanding of PCa etiology and predictors of poor outcomes remains limited. Screening can detect PCa at an early stage, but generalized use of screening of men at both high and low risk of unfavorable outcomes may result in unnecessary treatment for some and insufficient treatment in others. Thus, a critical public health goal is to optimize risk assessment and target cancer screening and treatment to reduce PCa mortality while minimizing over treatment and its negative side effects in men who are unlikely to experience unfavorable PCa outcomes. It is likely that the causes of unfavorable PCa outcomes are multifactorial and complex. Tumor and patient characteristics have been used to identify some men with poor prognosis. However, the potential additional contribution of biological or environmental factors to these predictive models is not well understood. The goals of the research proposed here are 1) to identify factors that predict PCa outcomes, and 2) to use this information to identify men who may benefit from specific screening and or treatment options. We hypothesize that long-term exposure to unfavorable individual-level and macro-environmental exposures influence PCa severity and access to health care. These exposures include area-level or neighborhood factors such as neighborhood deprivation and residential segregation. We further hypothesize that the response to these exposures is mediated by biomarkers. We propose to use a large, prospective cohort currently including 1,900 PCa cases with a projected average of 72 months of prospective follow at the time of analysis, tissue samples, geospatial data, questionnaire information, and medical records data to evaluate (1) the effect of tumor biomarkers on PCa aggressiveness and outcomes, (2) the effect of macroenvironmental contextual factors on biomarkers of unfavorable long-term exposures or PCa outcomes, and (3) Develop improved nomograms that include biomarkers, individual risk factors and macro-environmental factors (including factors identified in Project 1) to identify a multilevel set of predictors of PCa outcomes.

Public Health Relevance

Prostate cancer etiology and outcomes are likely influenced by multiple predictors including biology, individual exposures, and contextual macro-environmental (e.g., neighborhood) factors. This project will evaluate biomarkers and risk factors using a multilevel approach to better understand the causes of PCa outcomes and disparities, as well as build models that can be used to predict which men will experience unfavorable outcomes.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Comprehensive Center (P60)
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Special Emphasis Panel (ZMD1-RN (02))
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University of Pennsylvania
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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
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
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
Yamoah, Kosj; Walker, Amy; Spangler, Elaine et al. (2015) African-american race is a predictor of seminal vesicle invasion after radical prostatectomy. Clin Genitourin Cancer 13:e65-72
Yamoah, Kosj; Johnson, Michael H; Choeurng, Voleak et al. (2015) Novel Biomarker Signature That May Predict Aggressive Disease in African American Men With Prostate Cancer. J Clin Oncol 33:2789-96
Rebbeck, Timothy R; Haas, Gabriel P (2014) Temporal trends and racial disparities in global prostate cancer prevalence. Can J Urol 21:7496-506
Lynch, Shannon M; Rebbeck, Timothy R (2013) Bridging the gap between biologic, individual, and macroenvironmental factors in cancer: a multilevel approach. Cancer Epidemiol Biomarkers Prev 22:485-95