Geographic disparities and temporal trends in aggressive prostate cancer: a SEER population-based analysis (2004-2022).
7 affiliations
- 1Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
- 2Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, USA.
- 3The University of Texas at Austin, 2515 Speedway, Austin, TX, 2515, USA.
- 4Department of Radiation Oncology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
- 5Department of Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
- 6Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
- 7Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA. [email protected].
Abstract
Purpose
Prostate cancer burden may be amplified in rural regions or Appalachia areas, where access to screening and healthcare may be limited. This study examined geographic disparities and temporal trends in aggressive and metastatic prostate cancer across four groups defined by rurality and Appalachian status, while assessing assessed racial differences.Methods
We conducted a retrospective study using the Surveillance, Epidemiology, and End Results (SEER) including newly diagnosed prostate cancer men aged ≥40 years (2004-2022). Age-adjusted incidences of more aggressive and metastatic cases were estimated for each geographical region. Multivariable logistic regression was used to evaluate geographic and racial disparities in risk of more aggressive cases, adjusting for demographic and clinical factors.Results
We identified 951,965 eligible cases. Overall prostate cancer incidence declined in most regions, with a decrease in rural Appalachia (Annual percent changes [APC] = - 1.7%; 95% CI: [- 2.98%, - 0.42%]). Incidence of more aggressive cases increased over time particularly in urban Appalachia (APC = 2.73%; 95% CI: [1.20%, 4.65%]). For metastatic cases, urban Appalachia had the lowest overall incidence and rural non-Appalachia the highest, and rates increased across regions after 2020. In multivariable regression, geographic patterns differed by race. Among White men, compared with urban non-Appalachia, the odds of more aggressive prostate cancer were higher in rural non-Appalachia and rural Appalachia but lower in urban Appalachia. However, among Black men, those residing in rural Appalachia had significantly lower odds than those residing in urban non-Appalachia. Older age, Hispanic ethnicity, higher serum PSA, and lymph node-positive status were also associated with higher odds of more aggressive prostate cancer.Conclusion
Prostate cancer burden and severity varied by Appalachian status and rurality, supporting targeted, region- and race-specific strategies to improve early detection and access to high-quality care.
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BibTeX
@article{xu2026geographic,
title = {{Geographic disparities and temporal trends in aggressive prostate cancer: a SEER population-based analysis (2004-2022).}},
author = {Yifei Xu and Ayush Singh and Eric Li and Nicholas George Zaorsky and Nathaniel Geyer and Yifan Yang and Yanxu Yang and Alicia C McDonald and Lijun Zhang and Ming Wang},
journal = {Cancer causes \& control : CCC},
year = {2026},
month = oct,
doi = {10.1007/s10552-026-02267-5},
url = {https://europepmc.org/article/MED/42891738},
note = {CC BY},
}
RIS
TY - JOUR
TI - Geographic disparities and temporal trends in aggressive prostate cancer: a SEER population-based analysis (2004-2022).
AU - Yifei Xu
AU - Ayush Singh
AU - Eric Li
AU - Nicholas George Zaorsky
AU - Nathaniel Geyer
AU - Yifan Yang
AU - Yanxu Yang
AU - Alicia C McDonald
AU - Lijun Zhang
AU - Ming Wang
PY - 2026
DA - 2026/10/17
JO - Cancer causes & control : CCC
DO - 10.1007/s10552-026-02267-5
UR - https://europepmc.org/article/MED/42891738
AB - Purpose Prostate cancer burden may be amplified in rural regions or Appalachia areas, where access to screening and healthcare may be limited. This study examined geographic disparities and temporal trends in aggressive and metastatic prostate cancer across four groups defined by rurality and Appalachian status, while assessing assessed racial differences.Methods We conducted a retrospective study using the Surveillance, Epidemiology, and End Results (SEER) including newly diagnosed prostate cancer men aged ≥40 years (2004-2022). Age-adjusted incidences of more aggressive and metastatic cases were estimated for each geographical region. Multivariable logistic regression was used to evaluate geographic and racial disparities in risk of more aggressive cases, adjusting for demographic and clinical factors.Results We identified 951,965 eligible cases. Overall prostate cancer incidence declined in most regions, with a decrease in rural Appalachia (Annual percent changes [APC] = - 1.7%; 95% CI: [- 2.98%, - 0.42%]). Incidence of more aggressive cases increased over time particularly in urban Appalachia (APC = 2.73%; 95% CI: [1.20%, 4.65%]). For metastatic cases, urban Appalachia had the lowest overall incidence and rural non-Appalachia the highest, and rates increased across regions after 2020. In multivariable regression, geographic patterns differed by race. Among White men, compared with urban non-Appalachia, the odds of more aggressive prostate cancer were higher in rural non-Appalachia and rural Appalachia but lower in urban Appalachia. However, among Black men, those residing in rural Appalachia had significantly lower odds than those residing in urban non-Appalachia. Older age, Hispanic ethnicity, higher serum PSA, and lymph node-positive status were also associated with higher odds of more aggressive prostate cancer.Conclusion Prostate cancer burden and severity varied by Appalachian status and rurality, supporting targeted, region- and race-specific strategies to improve early detection and access to high-quality care.
SN - 0957-5243
SN - 1573-7225
ER -