title: Sociodemographic predictors of prostate cancer risk category at diagnosis: unique patterns of significant and insignificant disease.
abstract: OBJECTIVE
  We determined various sociodemographic predictors of prostate cancer risk category at presentation as assessed by serum prostate specific antigen, cancer grade and tumor stage.
  
  
  METHODS
  We performed a retrospective cohort study of 5,939 patients enrolled in the CaPSURE national disease registry database between 1995 and 2007. Prostate cancer risk category was assigned as low, intermediate or high based on diagnostic prostate specific antigen, clinical grade and biopsy Gleason grade. Additionally, a group of men with low grade, limited volume tumors were identified as having clinically insignificant disease. The primary outcome was prostate cancer risk category at presentation. Treatment received vs active surveillance was analyzed as a secondary end point.
  
  
  RESULTS
  Patients who were older, had lower levels of education and had Medicare with or without a supplement instead of private or Veteran's Affairs insurance were more likely to have intermediate and high risk disease than low risk disease. Nonwhite race was associated with high risk disease at presentation. Clinically insignificant disease was more common in men younger than 60 years, those with higher education and income, and those with private insurance. Logistic regression analysis suggested that younger age, higher education and income, and private insurance were related to insignificant disease being detected. Among men with insignificant disease younger age and private insurance were associated with immediate treatment with curative intent.
  
  
  CONCLUSIONS
  Unique sociodemographic variables are associated with the clinical risk of prostate cancer at diagnosis and they may influence treatment decisions and outcomes. Patients with insignificant disease may be susceptible to overtreatment due to the indolent nature of the disease. Intermediate and high risk groups, which are associated with poorer outcomes, may be further endangered by late detection of the disease.
authors.affiliation: Urologic Outcomes Research Group, Department of Urology, University of California-San Francisco, San Francisco, California, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Dall'era
authors.forename: Nap
authors.initials: N
authors.lastname: Hosang
authors.forename: Badrinath
authors.initials: B
authors.lastname: Konety
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cowan
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors