Environmental ills linked to aggressive prostate cancer diagnosis

Poor environmental quality is associated with greater odds of an advanced stage prostate cancer at diagnosis, with a study finding the strongest associations for lower water, land, sociodemographic quality.

Researchers used data from the Surveillance, Epidemiology, and End Results (SEER) database and included 252,164 prostate cancer patients (median age at diagnosis 66 years, 76 percent White). They used the county-level metric environmental quality index (EQI) to assess the overall ambient environmental quality index as well as five environmental quality subdomains (air, water, land, built, and sociodemographic).

The vast majority of patients (92 percent) in the cohort had localized disease at diagnosis, whereas only 8 percent had metastatic disease. In the localized prostate cancer group, 33 percent (n=75,912) of patients were high risk, 42 percent (n=98,226) were intermediate risk, 19 percent (n=43,646) were low risk, and 7 percent (n=15,249) were unknown at time of diagnosis.

Multivariable regression analysis showed that metastatic prostate cancer at diagnosis correlated with worse overall EQI (odds ratio [OR], 1.20, 95 percent confidence interval [CI], 1.15–1.26), water EQI (OR, 1.34, 95 percent CI, 1.27–1.40), land EQI (OR, 1.35, 95 percent CI, 1.29–1.42), and sociodemographic EQI (OR, 1.29, 95 percent CI, 1.23–1.35). There was a dose-response increase in the OR estimates from the lowest to the highest quintiles of EQI.

On further analysis, Black race emerged as an independent predictor of metastatic prostate cancer at diagnosis (OR, 1.36, 95 percent CI, 1.30–1.42). The association between overall EQI and metastatic prostate cancer was more pronounced among Black (OR, 1.53, 95 percent CI, 1.35–1.72) than White men (OR, 1.18, 95 percent CI, 1.12–1.24).

More studies are needed to establish specific modifiable environmental factors associated with aggressive prostate cancer.