Sperling Prostate Center

The Harsh Economics of Prostate Cancer

Over the years, I have written on various topics related to prostate health. The obvious ones include prostate cancer (PCa): how to detect, diagnose and treat it without wrecking quality of life and masculinity, nutrition, exercise, stress management, and even new drugs like metformin and rapamycin that were developed for other conditions but turn out to be advantageous for the prostate.  I have written about risk factors that increase the chances of developing PCa such as family history, age, ethnicity, gene mutations, exposure to environmental toxins, chronic inflammation or irritation, smoking, and obesity.

I have written about BPH, prostatitis, complementary and alternative medicine, and even the business side of prostate medicine.

However, there’s one fact of life I have not addressed. A recent article brought it to my attention, and it is a reality for millions of men and those who love them.  The fact is that being economically disadvantaged contributes to PCa and inferior outcomes in ways that have not been recognized. Now, a Canadian study brings this to light.

Connecting social and economic class with prostate cancer risk

The title of the published study by Madathil, et al. (2018)[i] is “Disadvantageous Socioeconomic Position at Specific Life Periods May Contribute to Prostate Cancer Risk and Aggressiveness.” That is a formal way of saying that being born into and raised in lower class and poor circumstances puts a man at risk of developing aggressive prostate cancer that is detected late. Furthermore, he likely won’t have access to the same quality of care as someone who is middle-to-upper class.

The authors used data from the PROtEuS study (Prostate Cancer & Environment Study) that included 1,930 PCa patients in Montreal. For the sake of comparison, the authors enrolled an additional 1,991 men to serve as controls. All enrollees were personally interviewed, and information about their economics, demographics, work history and lifestyle was recorded.

As a way of measuring the participants’ circumstances during their childhood and teen years, the authors reference the father’s longest occupation, and parents’ car ownership.

The Madathil paper is different from other such studies because it isn’t just a snapshot in time of an underclassed person. Instead, the authors’ goal was to correlate a man’s circumstances during “…childhood/adolescence, early- and late-adulthood, and risk of PCa overall as well as according to tumor aggressiveness at diagnosis.” The research team points out the rapid changes in the dormant gland that occur during adolescence when hormones surge, presumably a time when the physical changes in the body would be more vulnerable to demographic and environmental influences. There is cruel logic to the hypothesis that how one comes of age and matures in disadvantaged circumstances can set a man up for prostate cancer.

What the team found was that, compared with controls, the disadvantaged group had a roughly 50% greater chance of having PCa. Add to this possible lack of access to state-of-the-art clinical care and it creates a formula for worse outcomes than higher class men with PCa experience.

The authors note that there could be various explanations for their findings:

For example, a poor diet can disturb the pre-adulthood hormonal milieu … at the time when the prostate develops most quickly. This is reflected in lower height … and childhood obesity … Similarly, [socioeconomic disadvantage] in early years could lead to more stress, which is also known to negatively affect growth and development…

Adult [socioeconomic disadvantage] may also act through common risk factors such as health behaviors (e.g., tobacco smoking and excessive alcohol consumption) or obesity, which are more prevalent among individuals with [socioeconomic disadvantage]  … However, adjustment for these factors had a modest impact on results.

I believe this is an important study that brings to our attention the role that life factors play in increasing the odds of PCa or, for that matter, other diseases.  While there will always be economic differences in human society, I hope for the day when no man is at greater risk for prostate cancer due to his social and economic status. I would like to believe that we are capable of eliminating at least that risk factor.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Madathil S, Blaser C, Nicolau B, Richard H, Parent ME. Disadvantageous Socioeconomic Position at Specific Life Periods May Contribute to Prostate Cancer Risk and Aggressiveness. Front Oncol. 2018 Nov 15;8:515



About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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