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TheScientificWorldJOURNAL
Volume 6, Pages 2460-2470
http://dx.doi.org/10.1100/tsw.2006.383
Research Article

Comorbidities and the Risk of Late-Stage Prostate Cancer

1University of Kentucky College of Public Health, Lexington, KY, USA
2Centers for Disease Control and Prevention, Atlanta, GA, USA
3University of Kentucky, Family Practice & Community Medicine, Lexington, KY, USA
4Pfizer Inc., New London, CT, USA

Received 30 January 2006; Revised 6 June 2006; Accepted 6 June 2006

Academic Editor: Peter E. Clark

Copyright © 2006 Steven T. Fleming et al.

Abstract

The degree to which comorbidities affect the diagnosis of prostate cancer is not clear. The purpose of this study was to determine how comorbidities affect the stage at which prostate cancer is diagnosed in elderly white and black men. We obtained data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute merged with Medicare claims data. For each patient, we estimated associations between stage of disease at diagnosis and each of the 27 comorbidities. The sample included 2,489 black and 2,587 white men with staged prostate cancer. Coronary artery disease, benign hypertension, and dyslipidemia reduced the odds of late-stage prostate cancer. A prior diagnosis of peripheral vascular disease, severe renal disease, or substance abuse increased the odds of being diagnosed with late-stage disease. The study shows some effect modification by race, particularly among white men with substance abuse, cardiac conduction disorders, and other neurologic conditions. The strongest predictors of late-stage prostate cancer diagnosis for both white and black men were age at diagnosis of at least 80 years and lack of PSA screening. Comorbidities do affect stage at diagnosis, although in different ways. Four hypotheses are discussed to explain these findings.