AUA 2018: Association Between Environmental Quality and Prostate Cancer Stage at Diagnosis

San Francisco, CA ( Prostate cancer (PC) is reportedly up to 57% heritable, with the remainder attributed to exposures such as diet, medications, or environment. There are limited data regarding environmental exposures and PC aggressiveness, which was the focus of this study.  Using the Surveillance, Epidemiology, and End Results (SEER) database the authors identified PC cases reported between 2010 and 2014.

The environmental quality index (EQI) is a county-level metric combining data from 18 sources and is reported as an overall index, as well as 5 sub-domains (air, water, land, built, and sociodemographic) - with higher values representing lower environmental quality. Median values of EQI across categories were analyzed and compared. Multivariable logistic regression models adjusted for age at diagnosis (years) and self-reported race (white, black, other, unknown) were used to generate odds ratios (OR) with 95% confidence intervals (CI) to test associations between quintiles of EQI scores and advanced PC stage at diagnosis. 

The study cohort included 252,164 PC cases from 611 counties, of which 92% were localized and 8% metastatic at diagnosis. In the adjusted regression models, advanced age (OR 1.055/ yr, CI 1.053-1.057), black race (OR 1.305, CI 1.252-1.359), and EQI (OR 1.125, CI 1.068-1.184) were independently associated with metastatic PC at diagnosis. In addition, all subdomains of the EQI were associated with advanced PC stage (Figure 1). The strongest associations were seen in the water, land, and sociodemographic domains. For these domains, there was a dose response increase in the odds ratio from the lowest to the highest quintiles of EQI. 

UroToday AUA2018 MetastaticvslocalizedPCa

The authors concluded that lower environmental quality was associated with advanced stage PC at diagnosis. The water, land and sociodemographic domains showed the strongest associations. More work should be done to elucidate specific modifiable environmental factors associated with aggressive PC.

Presented by:  David T. Greenwald, Chicago, US
Co-Authors: Jyotsna S. Jagai, Chicago, IL, Achal P. Patel, Chapel Hill, NC, Daniel M. Moreira, Michael R. Abern, Chicago, IL

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA