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)
Project #
Application #
Study Section
Special Emphasis Panel (ZMD1-RN (02))
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
United States
Zip Code
Zeigler-Johnson, Charnita; Hudson, Aaron; Glanz, Karen et al. (2018) Performance of prostate cancer recurrence nomograms by obesity status: a retrospective analysis of a radical prostatectomy cohort. BMC Cancer 18:1061
Radhakrishnan, Archana; Grande, David; Mitra, Nandita et al. (2018) Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? Urology 115:133-138
Rebbeck, Timothy R; Sellers, Thomas A (2018) Editorial: The Fruits of the Genomic Revolution. Cancer Epidemiol Biomarkers Prev 27:362
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
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
Rebbeck, Timothy R (2017) Prostate Cancer Genetics: Variation by Race, Ethnicity, and Geography. Semin Radiat Oncol 27:3-10
Jeffers, Abra; Sochat, Vanessa; Kattan, Michael W et al. (2017) Predicting Prostate Cancer Recurrence After Radical Prostatectomy. Prostate 77:291-298
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
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

Showing the most recent 10 out of 18 publications