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Underinsured Men Present With Advanced Prostate Cancer At Nearly Four Times The National Average

San Diego, CA, May 7,2013 – A new study which evaluated a registry of largely underinsured men confirms poor survival and significant morbidity for those initially presenting with a prostate-specific antigen (PSA) of 100 ng/mL or greater (a sign of metastatic prostate cancer).  In fact, underinsured men were diagnosed with advanced prostate cancer at a rate of more than three times the national average and their five-year survival rate of 29 percent was well below the national average. The study will be presented to reporters at the 108th Annual Scientific Meeting of the American Urological Association (AUA) during a press conference at the San Diego Convention Center, San Diego, CA on May 7 at 1:30 p.m. PDT.

“The results of this study show underinsured men are being diagnosed with advanced prostate cancer more frequently than those with better health coverage. Even worse, their survival rate is substantially lower,” said Scott Eggener, MD, Associate Professor, Urologic Oncology, University of Chicago.“The study highlights disturbing disparities in healthcare access, utilization, and outcome for men with prostate cancer.”

Study Details

Study investigators created a prostate cancer registry of patients treated at Santa Clara Valley Medical Center, a county hospital in San Jose, California, which serves a large underinsured population. Investigators focused their study on men between 1998 and 2008 who presented with a PSA of 100 ng/mL.  Survival analysis was used to assess the effect of presenting PSA level, PSA nadir (including treatment), age, race, Gleason score and presence of bony metastasis at the time of initial workup. Investigators identified 71 men representing 14.4 percent of all the prostate cancers diagnosed during the time period studied. None of the men had received prior prostate cancer screenings at Santa Clara.

 Results showed:

  • The median PSA score at presentation was 399 ng/mL.
  • The median survival of this cohort was 18 months, less than 10 percent surviving beyond three years.
  • Patient survival was not significantly affected by presenting PSA, Gleason score, race and presence of bony metastasis at diagnosis.
  • A PSA nadir post therapy to <1 ng/mL and age <60 years at diagnosis were both associated with enhanced survival (p=.02 and <.001, respectively).
  • Associated morbidities included: hospitalization rate (64 percent), chronic catheterization (29 percent), spinal cord compression (19 percent) and compression fracture (17 percent).

Investigators concluded underinsured patients presented with advanced prostate cancer at nearly four times the national average of four percent. Furthermore, long-term survival was poor. Findings may warrant additional studies to explore the connection between insurance and prostate health.

NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange an interview with an expert, please contact the AUA Communications Office at the number above or e-mail

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 19,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.

Christine Frey, AUA