title: Disproportionate presentation of high risk prostate cancer in a safety net health system.
abstract: OBJECTIVE
  Most prostate cancer research is based on relatively homogenous cohorts of men, often with comparatively high socioeconomic status. We describe prostate cancer characteristics in men treated in a public health system and hypothesize a disproportionate burden of high risk disease in this population.
  
  
  METHODS
  We created a clinical registry from a review of the medical records of 377 men diagnosed with prostate cancer in the San Francisco General Hospital system, which provides care to underserved, uninsured populations. We compared sociodemographic data and cancer characteristics with those in 2 large prostate cancer databases from a community (CaPSURE™) and an academic (University of California-San Francisco tumor registry) setting to assess differences in risk distribution using the D'Amico and Cancer of the Prostate Risk Assessment scoring systems.
  
  
  RESULTS
  Compared to men in CaPSURE or the University of California-San Francisco tumor registry those in the San Francisco General Hospital cohort were nonwhite (76%), insured under Medicaid (31%) or uninsured (8%) and had adverse clinical characteristics, including median prostate specific antigen greater than 10 ng/ml at diagnosis and higher Gleason grade. In addition, the majority of patients (67%) had intermediate or high risk disease based on the D'Amico classification and a higher mean Cancer of the Prostate Risk Assessment score. Using ANOVA for continuous variables and the chi-square test for categorical variables, all comparisons were statistically significant (p <0.001).
  
  
  CONCLUSIONS
  Men in the San Francisco General Hospital public health system bear a substantially higher burden of high risk disease that those in an academic or a community setting. Populations such as this would benefit most from targeted efforts for early detection and treatment to decrease prostate cancer morbidity and mortality.
authors.affiliation: Department of Urology, University of California-San Francisco Helen Diller Family Comprehensive Cancer Center and San Francisco General Hospital, San Francisco, California 94143-1695, USA.
authors.forename: Sima P
authors.initials: SP
authors.lastname: Porten
authors.forename: Damien A
authors.initials: DA
authors.lastname: Richardson
authors.forename: Anobel Y
authors.initials: AY
authors.lastname: Odisho
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
mesh_terms: D000046:Academic Medical Centers; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology*; D017150:Public Sector; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States