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.

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)
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; Ross, Michelle et al. (2017) When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. J Am Board Fam Med 30:298-307
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

Showing the most recent 10 out of 18 publications