Genomic profiles in prostate cancer patients of varying measured socioeconomic inequality: A retrospective cohort study.

Abstract

e17159 Background: Socioeconomic inequality (SI) is a recognized risk factor for negative outcomes in prostate cancer (PCa), influenced by biology, healthcare access, and lifestyle. This study aims to explore the molecular impact of SI on PCa, focusing on targetable and prognostic biomarkers. Methods: We conducted a retrospective analysis of 100 metastatic hormone-sensitive PCa patients (2016-2023), with 97 undergoing next-generation sequencing (NGS). We examined only pathogenic variants alongside clinical variables. The Area Deprivation Index (ADI) assessed neighborhood SI, with higher scores indicating greater disadvantage. Patients were divided into tertiles. Chi-square and Fisher’s exact tests evaluated the relationships between tertiles and genomic alterations, while ordinal logistic regression analyzed outcomes by various stratifications. Results: Of the 97 patients, 29 were in tertile 1, 34 in tertile 2, and 35 in tertile 3. Tertile 1 had a significantly higher percentage of non-Hispanic patients (90%) compared to tertile 2 (62%) and tertile 3 (37%), p=0.0001. Other demographic factors, such as age, comorbidities, and cancer history, showed no significant differences by tertile. Median PSA levels increased from tertile 1 (22 ng/mL) to tertile 3 (95 ng/mL), although this was not statistically significant (p=0.14). Tumor volume and visceral metastasis were notably higher in tertile 3 (p=0.029 and p=0.02). BRCA1/2 mutations were more prevalent in tertile 3 (11%, p=0.03) via liquid biopsy compared to tertiles 1 and 2 (0%). TMPRSS2-ERG fusion mutations were significantly more common in tertile 3 (66.6%) compared to tertile 2 (19.1%) and tertile 1 (14.2%), p=0.009. The association between ADI tertile and TMPRSS2 approached significance when controlled for ethnicity (p=0.061), with Hispanic ethnicity having 3.5 times the odds of the fusion compared to non-Hispanics (p=0.02). Tertile 1 patients were more associated with receiving progressive therapy lines (2L p=0.01, 3L p=0.03, 4L p=0.04), but median time to subsequent treatment at 5 years was similar across tertiles (p=0.84). Conclusions: Higher SI was linked to increased PSA, tumor volume, visceral metastasis risk, and higher prevalence of BRCA1/2 and TMPRSS2-ERG mutations. This study highlights the need for further research on the molecular impacts of SI on adverse PCa outcomes, particularly among Hispanic populations.