Search Results (47)

RNA In Situ Hybridization (RISH) is a powerful tool for spatial gene expression analysis, yet its quantitative use remains limited by the high cost and inaccessibility of commercial software, particularly in under-resourced settings. This study developed an Artificial Intelligence/Machine Learning (AI/ML)-assisted RISH quantification pipeline to evaluate expression patterns of High Mobility Group AT Hook-2 (HMGA2) in prostate cancer (PCa), focusing on racial disparities. We created a machine learning model capable of analyzing RISH images. Expressions of full-length (wild-type) and truncated HMGA2 isoforms were assessed in tissues from 85 men of African descent, European American, and Asian descent. A training dataset was generated for supervised learning analysis of the full cohort. RISH findings revealed that the wild-type HMGA2 isoform was significantly more abundant in tumors from men of African descent and positively correlated with increasing Gleason grade. The truncated isoform was less abundant and did not display a consistent expression pattern across racial groups. These results demonstrate the feasibility of AI/ML-based RISH quantification and suggest that elevated wild-type HMGA2 expression may represent a biomarker linked to prostate cancer aggressiveness and racial disparities. These findings highlight the importance of interdisciplinary collaboration and equitable computational tools in advancing biomarker discovery and addressing cancer health inequities. Full article

Cancer is the second leading cause of death in the U.S., with 612,000 deaths estimated in 2023. Cancer screening (CS) reduces mortality through early detection, but the impact of chronic conditions like adult asthma (AA) on screening is less understood. This study explores the association between AA and uptake of prostate, breast, cervical, and colorectal CS using BRFSS 2016, 2018, 2020 and 2022 data. Weighted and adjusted multivariable logistic regression assessed the association between AA and CS across sex and age-based subgroups with significant effect modification testing and subsequent subgroup analyses. Results showed significantly higher CS adherence among individuals with AA across all four CS sites compared to counterparts without asthma (CCWA). Males (55–69 years old (YO)) with AA had 15% significantly higher weighted and adjusted odds (WAO) of prostate CS (95% CI: 1.04–1.27). Women (50–74 YO) with AA had 16% significantly higher WAO of breast CS (95% CI: 1.01–1.32), with non-depressed, heavy-drinking women showing 300% significantly higher WAO (95% CI: 2.20–7.22) of breast CS. Women (21–65 YO) with AA had 9% significantly higher WAO of cervical CS (95% CI: 1.02–1.17), with education significantly modifying the association (WAOR for college-educated women = 1.23, 95% CI: 1.11–1.36). When CCWA, colorectal CS showed significantly higher odds of 36% for men aged 50–75 (95% CI: 1.24–1.49) and 24% for women aged 50–75 (95% CI: 1.15–1.33). This is the first national study to examine the association between AA and uptake of prostate, female breast, cervical, and colorectal CS over four years. Individuals with AA had significantly greater odds of CS adherence than CCWA. Effect modification by heavy drinking and education suggests the need for targeted outreach and low-literacy interventions. Full article

Background: Prostate cancer is a major public health concern in Ghana, where most cases present late and mortality remains high. Community education is essential for improving awareness and early detection. Traditional health talks are widely used, but interactive approaches such as board games have received little evaluation. Aim: To compare the effectiveness of a Social Cognitive Theory–Socioecological Model-based literacy board game (S-S-LIBOG) with a traditional health talk in improving prostate cancer knowledge, attitudes, and perceptions. Methods: A quasi-experimental, two-arm interventional study was conducted in a semi-urban Ghanaian cohort. Participants (n = 197) were allocated to either the board game arm (n = 80) or the health talk arm (n = 61) after accounting for attrition. A structured questionnaire measured knowledge, attitudes, and perceptions (KAP) before and after intervention. Statistical analyses at 5% alpha level included chi-square tests, two-proportion Z-tests, Wilcoxon signed-rank tests, and multivariate logistic regression. Results: Among participants, 29.4% were female, 64.5% male, and 6.1% other genders. Tertiary education was reported by 81.7%, secondary 9.6%, postgraduate 5.6%, and primary 3.0%. Ethnicities: Ewe 41.6%, Akan 26.9%, Northern 13.7%, Ga 6.6%, Guan 1.5%, others 9.6%. Rural dwellers: 29.9%. LIBOG improved ‘good knowledge level’ from 35.0% at baseline to 60.0% post-intervention, compared to 35.0% to 62.3% by the Health Talk (HT). S-S-LIBOG also narrowed gender, education, and lifestyle disparities in KAP, with males showing higher odds of positive attitude (OR = 4.16, p = 0.004) and perception (OR = 2.79, p = 0.047), and rural residents having increased odds of good knowledge (OR = 4.39, p = 0.041) post—its intervention. HT similarly equalized disparities, except for perception, which remained linked to education. The significant improvements in knowledge were (LIBOG: z = 2.85, p = 0.004; HT: z = 3.10, p = 0.002). Even though health talks achieved higher overall knowledge gains, no statistically significant difference in overall effectiveness was observed between the two methods (Wilcoxon W = 102.0, p = 0.107). Acceptability of the board game was high, with over 80% of participants reporting satisfaction. Conclusions: The S-S-LIBOG board game was not inferior to the traditional health talk, showing particular strengths in enhancing attitudes and perceptions. Its interactive and culturally adapted design makes it a feasible adjunct to conventional health education methods. Future studies should examine long-term impacts and application in more diverse populations. This study was retrospectively registered by the Pan African Clinical Trial Registry on 10 October 2025; with the Trial Registration number PACTR202510512711680. Full article

Objectives: This study assessed socioeconomic inequalities in cancer screening at the district level in Peru, focusing on bilateral mammography, fecal occult blood test (FOBT), and prostate-specific antigen (PSA) test. Methods: An ecological study was conducted using 2021–2023 data from the Health Information System (HIS) of MINSA. Screening rates were calculated per 1000 eligible individuals. Socioeconomic disparities were assessed using concentration indices (CIs) and gap analysis, with the Human Development Index (HDI) as the stratification variable. Results: Screening rates were higher in districts with greater HDI. The mean district-level rates were 15.41 (SD: 72.66) for mammography, 97.27 (SD: 107.34) for FOBT, and 104.87 (SD: 101.92) for PSA per 1000 eligible individuals. Positive concentration indices indicated a pro-rich inequality: CI for mammography (0.1745, p = 0.045), FOBT (0.0633, p < 0.001), and PSA (0.0290, p = 0.028). The largest gaps were observed in Amazonian and Andean regions, where screening coverage remained markedly low. Spatial distribution revealed that certain districts, particularly in Loreto, Ucayali, and Amazonas, had screening gaps exceeding 97%. Conclusions: Significant disparities in cancer screening exist across Peruvian districts, disproportionately affecting lower-HDI districts areas. Targeted interventions, including education, telemedicine, and improved infrastructure, are necessary to enhance equitable access to early detection services and reduce the burden of disease. Full article

Background/Objectives: Prostate cancer (PCa) has the highest incidence and mortality rates among men in Puerto Rico. However, screening and early detection programs remain limited and fragmented. This study presents the design and implementation of a community-based educational program to increase PCa screening and knowledge in three southeastern rural communities with high African ancestry and elevated PCa mortality. Methods: Conducted between 2021 and 2025, this mixed-method study followed Community Engagement principles and was guided by the Intervention Mapping framework. A Community Advisory Committee informed each step of the intervention, which included PSA and digital rectal examination (DRE) testing via a mobile clinic staffed by urologists. Pre- and post-tests measured knowledge gains and willingness to screen, while satisfaction surveys evaluated the program’s impact. Results: After the intervention, knowledge scores increased significantly (t = −5.5, p < 0.001), and 76% of participants reported greater confidence in making health decisions. In total, 95 men accessed screening services through a mobile clinic, 33 were referred for follow-up, and 4 PCa cases were detected. Conclusions: Combining culturally tailored education with accessible screening helped overcome sociocultural and structural barriers, showing promise for reducing PCa disparities in underserved Puerto Rican populations. Full article

Background: This study evaluated the impact of diabetes mellitus (DM) and its treatments on cardiovascular outcomes in prostate cancer (PC) patients aged 66 years and older, with or without androgen deprivation therapy (ADT) exposure. Methods: Using the SEER-Medicare database (2009–2017), two cohorts were created: Cohort 1 included all PC patients enrolled in Medicare Parts A and B; Cohort 2 was a subset of Cohort 1 receiving ADT and enrolled in Medicare Part D. Exposures were DM and DM medications. Outcomes included cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm), and all-cause mortality, analyzed using multivariable Fine-Gray and Cox models. Results: Cohort 1 included 150,647 PC patients (32% with DM, median age 72). DM was associated with higher risk of CVE (subdistribution hazard ratio [sHR] 1.20, 95% CI 1.17–1.22), CVm (sHR 1.35, 1.28–1.43), and all-cause mortality (adjusted HR [aHR] 1.22, 1.19–1.26) (all p < 0.001). Non-Hispanic Blacks (NHBs) and patients from lower socioeconomic (SES) and education areas experienced comparable or worse outcomes. In Cohort 2 (n = 14,938), DM patients on non-metformin therapies had higher all-cause mortality (aHR 1.33, 1.11–1.25; p = 0.002) than those on metformin, particularly in NHB and low education groups. Sensitivity analyses with follow-up limited to two years showed consistent results as overall. Conclusions: Diabetic PC patients, especially NHB, lower SES and lower education subgroups, were associated with worse cardiovascular and all-cause mortality outcomes. Metformin may be associated with better outcomes in these populations, warranting further research on the disparities in PC and diabetes, and cardioprotective effects of DM medications across different subpopulations. Full article

Background/Objectives: Prostate cancer (PCa) is the second most common malignancy among men worldwide and a leading cause of cancer-related mortality. In 2022, over 1.4 million new cases were reported globally, with a prevalence exceeding 5 million. Despite its widespread occurrence, the incidence and mortality of PCa show substantial geographic variation, influenced by factors such as genetic predisposition, healthcare access, lifestyle, and the adoption of screening programs. Regions with high PCa incidence, such as Northern America and Oceania, often have lower mortality rates due to early detection and advanced healthcare infrastructure. Conversely, areas with limited access to medical resources, such as parts of Africa and Latin America, experience higher mortality rates. Methods: This review explores non-modifiable risk factors such as age, family history, and race, emphasizing their role in PCa development and progression. Results: Modifiable factors, including diet, physical activity, alcohol consumption, and smoking, are also addressed, with evidence suggesting their potential in mitigating risk. Emerging data on medications such as 5-alpha reductase inhibitors and statins, as well as dietary supplements such as vitamins D, indicate their potential for chemoprevention, though further research is needed to solidify these findings. Healthcare disparities, especially in low- and middle-income regions, highlight the need for equitable access to diagnostic tools and treatment options. The review underscores the significance of tailored screening approaches, particularly in high-risk populations, to optimize outcomes while minimizing overdiagnosis and overtreatment. Conclusions: The review concludes with recommendations for future research, including the need for standardized screening protocols and the exploration of novel biomarkers for early detection. By synthesizing epidemiological data and current evidence, this review aims to enhance understanding of PCa risk factors, geographic disparities, and preventive strategies, ultimately contributing to improved global PCa management and outcomes. Full article

Prostate cancer remains a major global health challenge, ranking as the second most common malignancy in men worldwide. Advances in diagnostic and therapeutic strategies have transformed its management, enhancing patient outcomes and quality of life. This review highlights recent breakthroughs in imaging, including multiparametric MRI and PSMA-PET, which have improved cancer detection and staging. Biomarker-based diagnostics, such as PHI and 4K Score, offer precise risk stratification, reducing unnecessary biopsies. Innovations in treatment, including robotic-assisted surgery, novel hormone therapies, immunotherapy, and PARP inhibitors, are redefining care for localized and advanced prostate cancer. Artificial intelligence (AI) and machine learning (ML) are emerging as powerful tools to optimize diagnostics, risk prediction, and treatment personalization. Additionally, advances in radiation therapy, such as IMRT and SBRT, provide targeted and effective options for high-risk patients. While these innovations have significantly improved survival and minimized overtreatment, challenges remain in optimizing therapy sequencing and addressing disparities in care. The integration of AI, theranostics, and gene-editing technologies holds immense promise for the future of prostate cancer management. Full article

Advances in screening, early detection, and therapeutic innovations have significantly improved survival rates, transforming prostate cancer into a chronic condition for many men. However, these strides have also revealed persistent challenges in survivorship, including treatment-related side effects, disparities in care, and inequities in outcomes. This review explores the complex landscape of prostate cancer survivorship, with a focus on demographic disparities, barriers to care, symptom burden, and treatment patterns. Our findings highlight how factors such as race, socioeconomic status, and insurance type heavily influence patient outcomes. For instance, Black and Latiné patients often face delays in treatment initiation and are less likely to receive definitive therapies than White patients, leading to poorer survival outcomes. Furthermore, those with Medicaid or no insurance are more likely to receive systemic therapy only or no treatment at all, exacerbating existing inequities. Addressing gaps in diagnosis, treatment access, and survivorship care is essential to developing targeted interventions and policies that promote equitable, patient-centered care for prostate cancer survivors. Full article

Background: Prostate cancer is recognised as the second most common diagnosed cancer in men and remains a significant global public health concern. In Ireland, the incidence of prostate cancer continues to rise, with approximately 1 in 6 men being diagnosed in their lifetime. Men’s experiences with prostate cancer are complex, necessitating further research into the factors influencing diagnosis and treatment. Therefore, this study aims to explore men’s experiences with prostate cancer, emphasising the interplay between screening, diagnosis, and the lived experiences of those affected. Methods: A qualitative descriptive study was conducted among men with prostate cancer in Ireland. Using a purposive sampling (n = 11) were interviewed with data saturation guiding sample size determination. A semi-structured interview guide was used for data collection either face-to-face or via Microsoft Teams and phone calls. Data were analysed using Braune and Clarke’s thematic analysis approach after transcription, with NVivo 12.0 software supporting analysis. Results: Thematic analysis identified five themes: systemic obstacle in timely cancer detection, the role of efficient system in cancer care, emotional resilience in cancer recovery, redefining normalcy post treatment and harnessing specialised support network in coping strategies. These themes were examined through the lens of the Biopsychosocial Model to understand their interconnected nature and impact on patient experiences. Conclusions: This study highlights the complex factors affecting prostate cancer patients’ experiences, emphasizing the need for a patient-centred approach, addressing systemic disparities, and promoting multidisciplinary care. It suggests implementing evidence-based survivorship care frameworks to improve quality of life for survivors, with future research exploring long-term effects of integrated care models. Full article

Prostate cancer is a leading cause of cancer-related morbidity and mortality worldwide, with diagnostic challenges magnified in underrepresented regions like sub-Saharan Africa. This study introduces a novel application of ConvNeXt, an advanced convolutional neural network architecture, for multi-class classification of prostate histopathological images into normal, benign, and malignant categories. The dataset, sourced from a tertiary healthcare institution in Nigeria, represents a typically underserved African population, addressing critical disparities in global diagnostic research. We also used the ProstateX dataset (2017) from The Cancer Imaging Archive (TCIA) to validate our result. A comprehensive pipeline was developed, leveraging advanced data augmentation, Grad-CAM for interpretability, and an ablation study to enhance model optimization and robustness. The ConvNeXt model achieved an accuracy of 98%, surpassing the performance of traditional CNNs (ResNet50, 93%; EfficientNet, 94%; DenseNet, 92%) and transformer-based models (ViT, 88%; CaiT, 86%; Swin Transformer, 95%; RegNet, 94%). Also, using the ProstateX dataset, the ConvNeXt model recorded 87.2%, 85.7%, 86.4%, and 0.92 as accuracy, recall, F1 score, and AUC, respectively, as validation results. Its hybrid architecture combines the strengths of CNNs and transformers, enabling superior feature extraction. Grad-CAM visualizations further enhance explainability, bridging the gap between computational predictions and clinical trust. Ablation studies demonstrated the contributions of data augmentation, optimizer selection, and learning rate tuning to model performance, highlighting its robustness and adaptability for deployment in low-resource settings. This study advances equitable health care by addressing the lack of regional representation in diagnostic datasets and employing a clinically aligned three-class classification approach. Combining high performance, interpretability, and scalability, this work establishes a foundation for future research on diverse and underrepresented populations, fostering global inclusivity in cancer diagnostics. Full article

Heterocyclic aromatic amines (HAAs), formed during the cooking of meat, are potential human carcinogens, underscoring the need for long-lived biomarkers to assess exposure and cancer risk. Frequent consumption of well-done meats containing 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), a prevalent HAA that is a prostatic carcinogen in rodents and DNA-damaging agent in human prostate cells, has been linked to aggressive prostate cancer (PC) pathology. African American (AA) men face nearly twice the risk for developing and dying from PC compared to White men. We previously demonstrated that scalp hair is a reliable biospecimen for measuring PhIP intake using liquid chromatography-mass spectrometry. This study aimed to determine whether PhIP dietary intake is higher in AA men, potentially contributing to this health disparity. Healthy AA men were found to have a significantly higher mean hair PhIP level (2.12-fold) than White men on free-choice diets. However, this difference was not statistically significant after adjusting for melanin content. Further research is needed to understand how hair pigmentation, follicular density, and other morphological features of hair influence PhIP accumulation. These insights can improve the accuracy of using hair PhIP levels as a biomarker for exposure and its potential associations with cancer risk. Full article

Our aim was to describe the incidence and mortality of genitourinary (GU) cancers in rural and urban Pennsylvania counties. We calculated age-adjusted incidence and mortality rates of GU (prostate, bladder, and kidney) cancers from 1990 to 2019 in the Pennsylvania Cancer Registry. We defined rurality using the Center for Rural Pennsylvania’s population density-based definition. We modeled average annual percent changes (AAPC) in age-adjusted incidence and mortality rates using joinpoint regression. Overall GU cancer incidence decreased in rural and urban counties (AAPC −7.5%, p = 0.04 and AAPC −6.6%, p = 0.02, respectively). Prostate cancer incidence decreased in rural and urban counties by −10.5% (p = 0.02) and −9.1% (p = 0.01), respectively. Kidney cancer incidence increased in both rural and urban counties, respectively (AAPC = +11.2, p = 0.002 and +9.3%, p = 0.01). GU cancer mortality decreased in rural and urban counties (AAPC = −11.6, p = 0.047 and AAPC −12.2, p = 0.01, respectively). Prostate cancer mortality decreased at similar rates in rural and urban counties (AAPC −15.5, p = 0.03 and −15.4, p = 0.02, respectively). Kidney cancer mortality decreased in urban (AAPC −6.9% p = 0.03) but remained stable in rural counties. Bladder cancer incidence and mortality were unchanged in both types of counties. Over three decades, GU cancer incidence and mortality decreased across Pennsylvania counties. Full article

Background: Technical efficiency evaluates a hospital’s economic performance and plays an important role in variations in quality of care and outcomes. The study objective was to examine the association between hospital efficiency and quality of care among fee-for-service Medicare beneficiaries with prostate cancer and to assess if race moderates this association. Design: Retrospective study using Surveillance, Epidemiological, and End Results—Medicare (SEER-Medicare) data from 1998 to 2016 for prostate cancer patients aged ≥ 66. We computed hospital technical efficiency using a data envelopment analysis. Outcomes were emergency room visits, hospitalizations, cost, and mortality (all-cause and prostate cancer-specific). We used competing risk regression for survival, log-link GLM models for cost, and Poisson models for count data. The propensity score approach was used to minimize selection bias. Results: The cohort consisted of 323,325 patients. Compared to higher efficiency hospitals (upper quartile), low hospital efficiency (i.e., lower quartile) was associated with a higher hazard of long-term mortality (Hazard ratio (HR) = 1.06, 95% CI = 1.05, 1.08) and long-term prostate cancer-specific mortality (HR = 1.14, 95% CI = 1.11, 1.17). Compared to higher efficiency levels, lower levels were associated with impaired emergency room visits, hospitalizations, and costs. A one unit increase in the efficiency score was associated with greater benefits for cost and mortality for African American and white patients. The benefit was larger for African American patients compared to white patients. Conclusions: Increasing hospital efficiency may help improve outcomes among Medicare prostate cancer patients. Policies to redirect patients to hospitals with higher efficiency can enhance the quality of care and outcomes. Full article

Our study sought to review and summarize the reported health disparities and inequities in the utilization of proton beam therapy (PBT) for prostate cancer. We queried the PubMed search engine through 12/2023 for original publications examining disparate utilization of PBT for prostate cancer. The query terms included the following: prostate cancer AND proton AND (disparities OR IMRT OR race OR insurance OR socioeconomic OR inequities)”. Studies were included if they involved United States patients, examined PBT in prostate cancer, and addressed health inequities. From this query, 22 studies met the inclusion criteria, comprising 13 population-based analyses, 5 single-institutional analyses, 3 cost/modeling investigations, and 1 survey-based study. The analyses revealed that in addition to age-related and insurance-related disparities, race and socioeconomic status played significant roles in the receipt of PBT. The likelihood of receiving PBT was lower for non-White patients in population-based and single-institution analyses. Socioeconomic metrics, such as higher median income and higher education level, portended an increased likelihood of receiving PBT. Conclusively, substantial age-based, racial, socioeconomic/insurance-related, and facility-associated disparities and inequities existed for PBT utilization in prostate cancer. The identification of these disparities provides a framework to better address these as the utility of PBT continues to expand across the US and globally. Full article