The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer

Saira Khan; Lindsay Fuzzell; Marvin Langston; Yunan Han; Justin X Moore; Keon Gilbert; Siobhan Sutcliffe; Jeannette T Bensen; James L Mohler; Elizabeth T H Fontham; Lixin Song; Marquita W Lewis-Thames

doi:10.1007/s10552-023-01821-9

The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer

Cancer Causes Control. 2024 Mar;35(3):531-539. doi: 10.1007/s10552-023-01821-9. Epub 2023 Nov 3.

Authors

Saira Khan^{1

2}, Lindsay Fuzzell³, Marvin Langston⁴, Yunan Han⁵, Justin X Moore⁶, Keon Gilbert⁷, Siobhan Sutcliffe^{5

8}, Jeannette T Bensen⁹, James L Mohler¹⁰, Elizabeth T H Fontham¹¹, Lixin Song¹², Marquita W Lewis-Thames¹³

Affiliations

¹ Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA. khans@wustl.edu.
² Epidemiology Program, College of Health Sciences, University of Delaware, 100 Discovery Blvd., 7th floor, Newark, DE, 19713, USA. khans@wustl.edu.
³ Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr. MRC-COEE, Tampa, FL, 33612, USA.
⁴ Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
⁵ Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 8100-0094-02300, 63110, USA.
⁶ Center for Health Equity Transformation, Department of Behavioral Science, Department of Internal Medicine, Markey Cancer Center, University of Kentucky College of Medicine, 760 Press Avenue, Lexington, KY, 40536, USA.
⁷ Department of Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis, University, 3545 Lafayette Ave., Room 316, St. Louis, MO, 63103, USA.
⁸ Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, 4921 Parkview Place, St. Louis, MO, 63110, USA.
⁹ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, 3130 Bioinformatics Building, CB# 7295, Chapel Hill, NC, 27599, USA.
¹⁰ Roswell Park Comprehensive Cancer Center, Elm and Carlton St, Buffalo, NY, 14263, USA.
¹¹ Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, USA.
¹² School of Nursing, University of North Carolina - Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC, 27599, USA.
¹³ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Dr, Chicago, IL, 60611, USA.

PMID: 37919455
DOI: 10.1007/s10552-023-01821-9

Abstract

Purpose: To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort.

Methods: The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer.

Results: Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men.

Conclusion: Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.

Keywords: Black men; Definitive treatment; High-aggressive tumors; Marital status; Prostate cancer; Screening.

MeSH terms

Early Detection of Cancer
Humans
Male
Marital Status
Prostate-Specific Antigen
Prostatic Neoplasms* / pathology
White

Substances

Prostate-Specific Antigen

Abstract

MeSH terms

Substances

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