title: Rural-urban differences in the clinico-pathologic profiles of Jamaican men with prostate cancer.
abstract: BACKGROUND
  Prostate cancer causes the highest number of cancer-related deaths in Jamaican men. It is not known whether rural-dwelling men present with worse disease than urban-dwelling men at initial presentation. Since rural and urban-dwelling Jamaicans are predominantly of African descent and generally similar in respect of racial composition, if any significant variation in initial presentation were found, it would suggest that these are likely due to differences in awareness, access to care, and screening patterns.
  
  
  METHODS
  The medical records of rural and urban-dwelling patients with prostate cancer were compared. Patients' age at presentation, initial prostate-specific antigen level, digital rectal examination findings, biopsy Gleason scores and initial treatment received were compared using bivariate and logistic regression analyses.
  
  
  RESULTS
  In unadjusted analyses rural-dwelling men were older compared to urban-dwelling men (72 years versus 68.5 years, p = 0.035), had higher median PSA values (22.9 ng/ml versus 18 ng/ml, p = 0.001), higher local tumour stage (65.2 % versus 34.8 % T3 disease; 73.7 % versus 26.3 % T4 disease; p = 0.005), higher mean Gleason scores (p = 0.048) and more non-curative initial treatments. Local tumour stage was the only statistically significant difference between rural and urban-dwelling men in logistic regression analysis with rural-dwelling men having a 70 % higher risk of locally-advanced disease (OR = 1.70, 95 % CI: 1.03-2.79; p = 0.038).
  
  
  CONCLUSIONS
  Rural-dwelling men presented with more advanced prostate cancer compared to urban-dwelling men. As both rural and urban-dwelling men are of predominant African descent it is likely that these differences are due to differences in access to care, screening practice and awareness of the disease.
authors.affiliation: Division of Urology, Section of Surgery, The Department of Surgery, Radiology, Anaesthesia & Intensive care, Faculty of Medical Sciences, University of the West Indies, Kingston 7, Mona, W.I. Jamaica.
authors.forename: William D
authors.initials: WD
authors.lastname: Aiken
authors.affiliation: Hargreaves Memorial Hospital, 32 Hargreaves Avenue Mandeville, Manchester, W.I. Jamaica.
authors.forename: Kieron S
authors.initials: KS
authors.lastname: Jones
authors.affiliation: The Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA.
authors.forename: Camille
authors.initials: C
authors.lastname: Ragin
authors.affiliation: Section of Community Health, The Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Kingston 7, Mona, W.I. Jamaica.
authors.forename: Kenneth
authors.initials: K
authors.lastname: James
keywords: African American; Awareness; Black men; Early detection of cancer; Health disparities; Health services accessibility; Prostate cancer; Rural population; Urban population