• Joan C Edwards School of Medicine, Huntington & WV, Department of Urology, Joan C Edwards School of Medicine, Huntington, WV

Micro-Abstract

Background: Data on prostate cancer presentation in Appalachia are scarce. Methods: We retrospectively reviewed 160 first-time transrectal ultrasound-guided prostate biopsies from 2022–2024 at a single Appalachian institution and compared them to 8,776 positive biopsies from the PLCO trial. Gleason scores were grouped as Grade Group 1 (≤6), 2/3 (7), 4 (8), and 5 (≥9). We used chi-square tests, Wilcoxon rank-sum tests, and sequential logistic regression to analyze grade distributions, age, and PSA differences. Results: Appalachian patients had higher rates of Grade Group 4 (19.1% vs. 7.9%) and Grade Group 5 disease (10.1% vs. 5.0%), older median age (e.g., Grade 1: 66 vs. 63 years, p = 0.0033), and higher median PSA (e.g., Grade 1: 8.6 vs. 5.7 ng/mL, p = 0.0001). In fully adjusted models, Grade 4 (OR 2.54, p = 0.002) and Grade 5 (OR 2.80, p = 0.002) remained independent predictors of Appalachian cohort membership. Conclusions: Appalachian patients exhibit a disproportionately high prevalence of advanced-grade prostate cancer, underscoring the need for region-specific early detection strategies.