In a study reported in JAMA Network Open, Balmaceda et al found that rural patients in North Carolina with newly diagnosed prostate cancer were more likely to experience biochemical recurrence than were urban patients.
Study Details
This cohort study used data from the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study, a population-based cohort following patients with newly diagnosed prostate cancer from the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry from January 2011 to June 2013. Eligible patients had received either surgery or radiation therapy within 1 year of diagnosis. Biochemical recurrence was defined as a prostate-specific antigen level > 0.2 ng/mL after radical prostatectomy or 2 ng/mL above the postradiation therapy nadir.
Key Findings
Among the 778 men included in the analysis, 191 (24.6%) resided in a rural setting. In addition, 213 (27.4%) were Black, the mean patient age was 63 ± 7.4 years, 370 (47.6%) were in the National Comprehensive Cancer Network (NCCN) intermediate-risk group, 449 (57.7%) were treated with radical prostatectomy, and 350 (45.1%) had Medicare insurance.
Overall, 82 patients (10.5%) experienced biochemical recurrence at a median follow-up of 4.6 years (interquartile range = 2.0–6.9 years). On univariable analysis, rural patients had a significantly higher rate of recurrence vs urban patients (16.8% vs 8.5%, hazard ratio [HR] = 2.19, 95% confidence interval [CI] = 1.38–3.46, P < .001). Greater risk of recurrence was also observed for the NCCN high- vs low-risk group (HR = 4.13, 95% CI = 2.25–7.57, P < .001) and those who had < 12 vs ≥ 12 biopsies (HR = 1.70, 95% CI = 1.08–2.67, P = .02).
On multivariable analysis adjusting for location of residence, marital status, overall health, number of cores biopsied, NCCN risk group, and treatment type, rural residence was independently associated with an increased risk of biochemical recurrence (HR = 1.74, 95% CI = 1.07–2.82, P = .03); receipt of radiation therapy was associated with a reduced recurrence risk (HR = 0.51, 95% CI = 0.31–0.85, P = .01).
The investigators concluded: “In this cohort study of patients with newly diagnosed prostate cancer, rural patients with prostate cancer had higher rates of biochemical recurrence. The etiology of this disparity is unclear but is likely multifactorial. Factors that may play a role include socioeconomic status, delay and disruptions in care, and access to multidisciplinary cancer care.”
Julia B. Balmaceda, MD, of the Department of Internal Medicine, University of Kansas Medical Center, Kansas City, is the corresponding author of the JAMA Network Open article.
Disclosure: The study was supported by the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, and the Department of Defense Prostate Cancer Research Program. For full disclosures of all study authors, visit jamanetwork.com.
