Abstract 4941: Psychosocial factors in association with overall survival after prostate cancer diagnosis among predominantly low-income Black and White adults
Authors: Douglas DeMoulin, Loren Lipworth, Melinda Aldrich, Heather Munro, Ronald Fisa, Kabisa Mwala, Martha J. Shrubsole, Wei Zheng, Xiao-Ou Shu
Journal: Cancer Research (2025)

Abstract Background: Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the US. Psychosocial factors may influence prostate cancer survival, but this association has not been investigated among a low-income population, particularly in Black men. Methods: This study used resources of the Southern Community Cohort Study (SCCS), a prospective cohort study of ∼85, 000 individuals aged 40-79, from predominantly low-income backgrounds, enrolled between 2002-2009 across 12 southeastern states. A total of 1, 367 men (309 white and 1, 058 black) newly diagnosed with prostate cancer during follow-up of 34, 313 SCCS male participants were included. At recruitment, information was obtained on psychosocial variables (including depressive symptoms, religious and spiritual beliefs and practices, and social support) along with sociodemographic, behavioral, and lifestyle factors and medical history. The Kaplan-Meier method was used to generate 5-year survival rates. Statistical significance was assessed using the log-rank test. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for mortality in association with psychosocial variables with adjustment for potential confounders. Results: Over 18 years of follow-up among participants with prostate cancer, 291 Black (27.5%) and 59 White patients died (19.1%) (P = 0.03). White men with prostate cancer self-reporting major depressive symptoms had an 11% lower 5-year survival (Psurvival = 0.01) and were at higher risk of dying (aHR = 2.26, 95% CI = 1.02-5.03) compared to White men reporting no depressive symptoms. There was a 41% higher risk of death per standard deviation increase of depression score (95% CI = 1.05-1.88). The depression-mortality association was attenuated after adjusting for inability to control important things in life (aHR = 1.61, 95% CI = 0.62-4.23) and marital status (aHR = 1.97, 95% CI = 0.87-4.46). Additionally, White men self-reporting inability to control important things in life as “much, most, or all of the time” had a 12% lower 5-year survival (Psurvival = 0.01) and were at increased risk of dying (aHR = 2.30, 95% CI = 1.07-4.95) compared to White men reporting “rarely or none of the time”. No statistically significant associations were found among Black men with prostate cancer. Testing for multiplicative interaction was significant for race-depression (Pinteraction &amp;lt; 0.01) and race- inability to control for important things in life (Pinteraction = 0.01). Conclusion: The associations between psychosocial factors and mortality among prostate cancer patients are complex and may not affect all individuals equally. Programs aiming to reduce mortality for individuals with prostate cancer need to take into consideration their psychosocial needs and demographic background. Citation Format: Douglas DeMoulin, Loren Lipworth, Melinda Aldrich, Heather Munro, Ronald Fisa, Kabisa Mwala, Martha J. Shrubsole, Wei Zheng, Xiao-Ou Shu. Psychosocial factors in association with overall survival after prostate cancer diagnosis among predominantly low-income Black and White adults [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4941.