Journal of Immigrant and Minority Health

, Volume 15, Issue 4, pp 803–809 | Cite as

Clinical Profile, Quality of Care, and Recurrence in Arab-American and Caucasians Prostate Cancer Patients in Michigan

  • Ahmad H. Moussawi
  • May Yassine
  • Subhojit Dey
  • Amr S. Soliman
Original Paper


Prostate cancer is the most common cancer among men in the United States with striking differences in incidence and mortality among ethnic groups. Michigan has one of the largest concentrations of Arab Americans (AAs) in the U.S. and little is known about this ethnic minority with respect to prostate cancer. This study investigated differences in clinical profile, quality of care, and recurrence among prostate cancer survivors comparing AAs and Caucasian Americans (CAs). Participants in this study included 2499 prostate cancer survivors from the Michigan Cancer Registry from 1985 to 2004. Participants completed surveys regarding health-seeking behavior, post-treatment symptoms, quality of care and recurrence. Ethnicity was self-reported and AAs and CAs were compared with respect to clinical profile, quality of care, and recurrence. There were 52 AAs and 1886 CAs patients with AAs being younger (\( \bar{x} \) age 68.3 ± SD 21.4 years, \( \bar{x} \) age 72.3 ± SD 14.1 years, for AAs and CAs, respectively) (P = 0.05). AAs had lower socioeconomic standard than CAs (34 vs. 10.6 %, <$20,000 yearly income/year; for AAs vs. CAs, respectively) (P < 0.0001). AAs reported poorer health than AAs (7.7 vs. 3.0 % for AAs vs. CAs, respectively) (P < 0.0001). AAs were more likely to visit specialists for prostate follow-up (44.5 vs. 19.7 % visited a specialist, for AAs vs. CAs respectively) (P < 0.0001) and received supplementary healthcare workers (13 % of AAs vs. 3.1 % CAs) (P = 0.032). In addition, AAs reported higher occurrence of urinary incontinence compared to CAs (67.4 vs. 60.4 %, for AAs vs. CAs, respectively) (P = 0.001). Ethnic background was not a predictor of recurrence [(Odds ratio (OR) = 1.1 (95 % confidence intervals CI = 0.40, 2.9)] (P = 0.873) even after adjusting for age, PSA levels within the last 2 years, metastasis and hormonal therapy. While AAs prostate cancer patients were different from CAs in age, income, seeking medical care, and health reporting, ethnic background was not a predictor of recurrence. Future studies of the impact of socioeconomic, demographic and cultural factors, and health care seeking behavior on long-term survival of prostate cancer in AAs and other ethnic minorities are warranted.


Prostate cancer Arab-Americans Ethnic minorities Quality of care Treatment Survivorship 


  1. 1.
    SEER U. 2011; 2/16/2011. Available from:
  2. 2.
  3. 3.
    Jones BA et al. Explaining the race difference in prostate cancer stage at diagnosis. Cancer Epidemiol Biomarkers Preven. 2008;17(10):2825–34.Google Scholar
  4. 4.
    El-Sayed AM, Galea S. The health of Arab-Americans living in the United States: a systematic review of the literature. BMC public health. 2009;9:272.CrossRefPubMedGoogle Scholar
  5. 5.
    Arab American Institute Foundation. Michigan: State’s rank by Arab American population: Census estimate of Arab American population. Washington, DC: Arab American Institute Foundation; 2011.Google Scholar
  6. 6.
    Kato I et al. Patterns of cancer in first generation immigrants from the Arab League and other countries. J Regist Manag. 2009;36(3):71–6; quiz 101–2.Google Scholar
  7. 7.
    Schwartz KL, et al. Cancer among Arab Americans in the metropolitan Detroit area. Ethn Dis. 2004;14(1):141–6.PubMedGoogle Scholar
  8. 8.
    Wei JT, et al. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000;56(6):899–905.CrossRefPubMedGoogle Scholar
  9. 9.
    Ghafoor M, Schuyten R, Bener A. Epidemiology of prostate cancer in United Arab Emirates. Med J Malays. 2003;58(5):712–6.Google Scholar
  10. 10.
    Freedman LS, I. National Cancer, and C. Middle East Cancer. Cancer incidence in four member countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC) compared with US SEER. 2006. Available from:
  11. 11.
    Thomas DC, Umar A, Kunkel TA. Microsatellite instability and mismatch repair defects in cancer. Mutat Res. 1996;350(1):201–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Zogby International. What Arabs think raw data. Utica, NY: Zogby International; 2002. p. 2 (CD-ROMs).Google Scholar
  13. 13.
    Sanderson M, et al. A multilevel analysis of socioeconomic status and prostate cancer risk. Ann Epidemiol. 2006;16(12):901–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Hellenthal NJ, et al. Men of higher socioeconomic status have improved outcomes after radical prostatectomy for localized prostate cancer. Urology. 2010;76(6):1409–13.CrossRefPubMedGoogle Scholar
  15. 15.
    Schwartz K, et al. Interplay of race, socioeconomic status, and treatment on survival of patients with prostate cancer. Urology. 2009;74(6):1296–302.CrossRefPubMedGoogle Scholar
  16. 16.
    Dundes A. The Evil eye: a casebook, vol ix. Madison, Wis.: University of Wisconsin Press; 1992. p. 318.Google Scholar
  17. 17.
    Osman H, Romani M, Hlais S. Family medicine in arab countries. Family Med. 2011;43(1):37–42.Google Scholar
  18. 18.
    Orsola A, Morote J. Epidemiology of urinary incontinence in prostate cancer. Incidence, quality of life and farmacoeconomic features. Arch Esp Urol. 2009;62(10):786–92.CrossRefPubMedGoogle Scholar
  19. 19.
    Parsons BA, Evans S, Wright MP. Prostate cancer and urinary incontinence. Maturitas. 2009;63(4):323–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Belka C, Ganswindt U. Recurrence of prostate cancer–value of salvage radiotherapy. Der Urologe Ausg A. 2006;45(10):1266–70.CrossRefPubMedGoogle Scholar
  21. 21.
    Sandhu JS, Eastham JA. Factors predicting early return of continence after radical prostatectomy. Curr Urol Rep. 2010;11(3):191–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Simonin O et al. [Urinary incontinence following open prostatectomy or laparoscopy for local prostate cancer. A review of relevant literature]. Progres en urologie: journal de l’Association francaise d’urologie et de la Societe francaise d’urologie, 2010;20(4):239–50.Google Scholar
  23. 23.
    Jang TL, et al. Physician visits prior to treatment for clinically localized prostate cancer. Arch Intern Med. 2010;170(5):440–50.CrossRefPubMedGoogle Scholar
  24. 24.
    Tzou K, Tan WW, Buskirk S. Treatment of men with rising prostate-specific antigen levels following radical prostatectomy. Expert Rev Anticancer Ther. 2011;11(1):125–36.CrossRefPubMedGoogle Scholar
  25. 25.
    Schmid HP, Keuler FU, Altwein JE. Rising prostate-specific antigen after primary treatment of prostate cancer: sequential hormone manipulation. Urol Int. 2007;79(2):95–104.CrossRefPubMedGoogle Scholar
  26. 26.
    Census U. 2000; 2/16/2011. Available from:
  27. 27.
    Smith T, Stein KD, Mehta CC, Kaw C, Kepner JL, Buskirk T, Stafford J, Baker F. The rational, design, and implementation of the American Cancer Society’s studies of cancer survivors. Cancer. 2007;109:1–12.CrossRefPubMedGoogle Scholar
  28. 28.
    Dallo FJ et al. Mortality rates among Arab Americans in Michigan. J Immigr Minor Health. 2012;14:236–41.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Ahmad H. Moussawi
    • 1
  • May Yassine
    • 2
  • Subhojit Dey
    • 3
  • Amr S. Soliman
    • 1
  1. 1.Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborUSA
  2. 2.Cancer Control Services Program, Michigan Public Health InstituteOkemosUSA
  3. 3.Indian Institute of Public Health, DelhiPublic Health Foundation of IndiaNew DelhiIndia

Personalised recommendations