Temporal and spatial trends and determinants of aggressive prostate cancer among Black and White men with prostate cancer

  • Ming Wang
  • Guangqing Chi
  • Yosef Bodovski
  • Sheldon L. Holder
  • Eugene J. Lengerich
  • Emily Wasserman
  • Alicia C. McDonaldEmail author
Original Paper



Few studies have reported temporal and spatial trends of aggressive prostate cancer (PC) among black men who are known to have more aggressive disease. We examined these trends for highly aggressive PC at diagnosis among black and white men in Pennsylvania (PA).


Men, aged ≥ 40 years, with a primary, clinical PC diagnosis were identified from the Pennsylvania Cancer Registry, 2004–2014. Joinpoint analysis was used to evaluate the temporal trend of highly aggressive PC (clinical/pathologic Gleason score ≥ 7 [4 + 3], clinical/pathologic tumor stage ≥ T3, or distant metastasis) and identify change points by race in which annual percent change (APC) was calculated. Logistic regression analyses were used to examine the association between race and highly aggressive PC, after adjusting for covariates with and without spatial dependence.


There were 89,133 PC cases, which included 88.7% white and 11.3% black men. The APC of highly aggressive PC was 8.7% from 2011 to 2014 among white men and 3.6% from 2007 to 2014 among black men (p values ≤ 0.01). The greatest odds of having highly aggressive PC among black compared to white men were found in counties where the black male population was ≤ 5.3%.


Highly aggressive PC increased for both black and white men in PA between 2004 and 2014. Black men had more aggressive disease, with the greatest odds in counties where the black male population was small. The increase in highly aggressive PC may be due to less screening for PC, resulting in more advanced disease at diagnosis.


Prostate cancer Aggressiveness Health disparities Spatial analysis 



A special thanks to James Rubertone for data extraction and other inquiries related to the Pennsylvania Cancer Registry.


This study was supported by The Eberly Medical Research Endowment Innovation Fund at the Pennsylvania State University College of Medicine, The Pennsylvania State Clinical and Translational Science Institute (CTSI) Novel Methodologies in Health Research (5 UL1 RR0330184-04), and Highmark Incorporation Grant at Penn State Cancer Institute.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study used existing data which allowed to waive informed consent and was approved by the Pennsylvania Department of Health and the Institutional Review Board of The Pennsylvania State College of Medicine.

Supplementary material

10552_2019_1249_MOESM1_ESM.docx (25 kb)
Supplementary file1 (DOCX 24 kb)
10552_2019_1249_MOESM2_ESM.docx (18 kb)
Supplementary file2 (DOCX 17 kb)


  1. 1.
    ACS (2018) Cancer facts & figures 2018. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    Wood HM, Reuther AM, Gilligan TD, Kupelian PA, Modlin CS, Klein EA (2007) Rates of biochemical remission remain higher in black men compared to white men after radical prostatectomy despite similar trends in prostate specific antigen induced stage migration. J Urol 178(4):1271–1276CrossRefGoogle Scholar
  3. 3.
    SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations) (2009) National Cancer Institute. Accessed 2012Google Scholar
  4. 4.
    Godley PA, Schenck AP, Amamoo MA, Schoenbach VJ, Peacock S, Manning M, Symons M, Talcott JA (2003) Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer. J Natl Cancer Inst 95(22):1702–1710CrossRefGoogle Scholar
  5. 5.
    Bhardwaj A, Srivastava SK, Khan MA, Prajapati VK, Singh S, Carter JE, Singh AP (2017) Racial disparities in prostate cancer: a molecular perspective. Front Biosci (Landmark edition) 22:772–782CrossRefGoogle Scholar
  6. 6.
    SEER Cancer Statistics Review, 1975–2016 (2018) National Cancer Institute. Accessed 9 Feb 2019
  7. 7.
    Kelly SP, Anderson WF, Rosenberg PS, Cook MB (2018) Past, current, and future incidence rates and burden of metastatic prostate cancer in the United States. Eur Urol Focus 4(1):121–127. CrossRefPubMedGoogle Scholar
  8. 8.
    Gejerman G, Ciccone P, Goldstein M, Lanteri V, Schlecker B, Sanzone J, Esposito M, Rome S, Ciccone M, Margolis E, Simon R, Guo Y, Pentakota SR, Sadhegi-Nejad H (2017) US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses. Investig Clin Urol 58(6):423–428. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Weiner AB, Matulewicz RS, Eggener SE, Schaeffer EM (2016) Increasing incidence of metastatic prostate cancer in the United States (2004–2013). Prostate Cancer Prostatic Dis 19(4):395–397. CrossRefPubMedGoogle Scholar
  10. 10.
    Bureau USC (2010) Geographic terms and concepts—urban and rural, 2017.
  11. 11.
    Kim HJ, Fay MP, Feuer EJ, Midthune DN (2000) Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 19(3):335–351CrossRefGoogle Scholar
  12. 12.
    Rodrigues M, de la Riva J, Fotheringham S (2014) Modeling the spatial variation of the explanatory factors of human-caused wildfires in Spain using geographically weighted logistic regression. Appl Geogr 48:52–63. CrossRefGoogle Scholar
  13. 13.
    Cardozo OD, García-Palomares JC, Gutiérrez J (2012) Application of geographically weighted regression to the direct forecasting of transit ridership at station-level. Appl Geogr 34:548–558. CrossRefGoogle Scholar
  14. 14.
    Chen D-R, Truong K (2012) Using multilevel modeling and geographically weighted regression to identify spatial variations in the relationship between place-level disadvantages and obesity in Taiwan. Appl Geogr 32(2):737–745. CrossRefGoogle Scholar
  15. 15.
    Chi G, Wang D (2016) Small-area population forecasting: a geographically weighted regression approach. In: Swanson D (ed) The frontiers of applied demography. Springer, New York, pp 449–471Google Scholar
  16. 16.
    Team RC (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, AustriaGoogle Scholar
  17. 17.
    Institute ESR (2009) ArcGIS Desktop Help 9.3 Geostatistical Analyst. Redlands, CAGoogle Scholar
  18. 18.
    Bureau USC (2018) Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2017 U.S. Census Bureau, Population Division. Accessed 1/18/19 2019
  19. 19.
    DeSantis CE, Siegel RL, Sauer AG, Miller KD, Fedewa SA, Alcaraz KI, Jemal A (2016) Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA 66(4):290–308. Google Scholar
  20. 20.
    Health PDo (2017) Cancer facts and figures Pennsylvania, 2017 (trans: Informatics DoH). Pennsylvania Department of Health, Harrisburg, PAGoogle Scholar
  21. 21.
    Wang M, Matthews SA, Iskandarani K, Li Y, Li Z, Chinchilli VM, Zhang L (2017) Spatial-temporal analysis of prostate cancer incidence from the Pennsylvania Cancer Registry, 2000–2011. Geospat Health 12(2):611. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Reese AC, Wessel SR, Fisher SG, Mydlo JH (2016) Evidence of prostate cancer “reverse stage migration” toward more advanced disease at diagnosis: data from the Pennsylvania Cancer Registry. Urol Oncol 34(8):e321–e328. CrossRefGoogle Scholar
  23. 23.
    Calonge N, Petitti DB, Dewitt TG, Dietrich AJ, Gregory KD, Harris R, Isham GJ, Lefevre ML, Leipzig R, Loveland-Cherry C, Marion LN (2008) Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 149(3):185–191Google Scholar
  24. 24.
    Moyer VA (2012) Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 157 (2):120–134. CrossRefGoogle Scholar
  25. 25.
    Downer MK, Stampfer MJ, Cooperberg MR (2017) Declining incidence rates of prostate cancer in the United States: is this good news or not? JAMA Oncol 3(12):1623–1624. CrossRefPubMedGoogle Scholar
  26. 26.
    Jemal A, Ward E, Wu X, Martin HJ, McLaughlin CC, Thun MJ (2005) Geographic patterns of prostate cancer mortality and variations in access to medical care in the United States. Cancer Epidemiol Biomark Prev 14(3):590–595. CrossRefGoogle Scholar
  27. 27.
    Ong MS, Mandl KD (2017) Trends in prostate-specific antigen screening and prostate cancer interventions 3 years after the U.S. Preventive Services Task Force Recommendation. Ann Intern Med 166(6):451–452. CrossRefGoogle Scholar
  28. 28.
    Network ACC (2009) The Cancer Burden in Appalachia.Google Scholar
  29. 29.
    Commission AR (2019) The Appalachian Region. Appalachia Regional Commission.
  30. 30.
    Antwi S, Tucker TC, Coker AL, Fleming ST (2013) Racial disparities in survival after diagnosis of prostate cancer in Kentucky, 2001–2010. Am J Men's Health 7(4):306–316. CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ming Wang
    • 1
    • 5
  • Guangqing Chi
    • 2
    • 3
  • Yosef Bodovski
    • 3
  • Sheldon L. Holder
    • 4
  • Eugene J. Lengerich
    • 1
    • 5
  • Emily Wasserman
    • 1
  • Alicia C. McDonald
    • 1
    • 5
    • 6
    Email author
  1. 1.Department of Public Health SciencesPennsylvania State University College of MedicineHersheyUSA
  2. 2.Department of Agricultural Economics, Sociology and EducationPennsylvania State UniversityUniversity ParkUSA
  3. 3.Computational and Spatial Analysis Core of the Social Science Research Institute and Population Research InstitutePennsylvania State UniversityUniversity ParkUSA
  4. 4.Division of Hematology/Oncology Penn State Cancer InstitutePennsylvania State UniversityHersheyUSA
  5. 5.Penn State Cancer InstitutePennsylvania State UniversityHersheyUSA
  6. 6.Pennsylvania State University College of MedicineHersheyUSA

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