Introduction

The Hispanic community in the US has experienced significant growth, with the US Census Bureau reporting a 23% increase in the Hispanic population over the past decade. The 2020 census recorded a total of 62.1 million Hispanic individuals, representing 19% of the total US population. Projections from the Associated Press anticipate that Hispanics will constitute over one-quarter of the US population by the year 2050.

Previous research has revealed distinctive patterns of genitourinary (GU) malignancies within the Hispanic population. Prior studies show lower rates of GU cancer among Hispanic men compared to non-Hispanic Whites (NHWs).¹ However, Hispanic men have greater odds of presenting with high-risk localized prostate cancer and greater odds of metastatic prostate cancer, despite lower overall disease risk.^2,3 Hispanic men have also been shown to have worse survival across all stages of prostate cancer.⁴

As the Hispanic demographic continues to grow, it is important to investigate and understand the unique epidemiologic characteristics. Our study aims to evaluate the contemporary burden of GU malignancies, specifically among Hispanic men, utilizing recent National Cancer Database (NCDB) Public Benchmarks Reports.

Materials and Methods

Data were obtained from the NCDB Public Benchmark Reports. The study included all male patients diagnosed with GU malignancy, including prostate, bladder, renal, testicular, penile, and ureteral cancer. Patients diagnosed between 2019 and 2021 were included in the study. The patients were then stratified by race/ethnicity.

The proportion of diagnoses in Hispanic men was calculated for each cancer subtype (Hispanic diagnoses of cancer X/all diagnoses of cancer X). The proportion of GU cancer by subtype (prostate, bladder, kidney, testis, penile, ureteral) was calculated for all men and for Hispanic men (cancer X diagnoses/all GU cancer diagnoses).

Results

A total of 677,440 patients with GU malignancies were identified. Of these men 40,937 (6.0%) identified as Hispanic. Of the 424,596 men with prostate cancer 23,412 (5.5%) were Hispanic. Of the 120,278 men with bladder cancer 4,687 (3.9%) were Hispanic. Of the 104,365 patients with renal cancer 8,945 (8.6%) were Hispanic. Of the 18,873 men with testis cancer 3,118 (16.5%) were Hispanic. Of the 5,147 men with ureteral cancer 206 (4%) were Hispanic. Of the 4,181 men with penile cancer 569 (13.6%) were Hispanic (Figure 1).

Figure 1. Proportion of Hispanic patients by cancer type.

Among all men with GU malignancies 62.7% had prostate cancer, 17.8% had bladder cancer, 15.4% had kidney cancer, 2.8% had testis cancer, 0.8% had ureteral cancer, and 0.6% had penile cancer. Among Hispanic men with GU malignancies 57.2% had prostate cancer, 11.4% had bladder cancer, 21.9% had kidney cancer, 7.6% had testis cancer, 0.5% had ureteral cancer, and 1.4% had penile cancer (Figure 2).

Figure 2. Specific genitourinary (GU) malignancy proportion of all GU malignancies.

Discussion

While the overall US population is 19% Hispanic, the representation of Hispanic men in male GU malignancies is notably lower at 6.0%. This discrepancy becomes more nuanced when examining specific cancer types, revealing higher proportions of Hispanic men with testis and penile cancers (16.5% and 12.5%, respectively) and lower proportions with prostate and bladder cancers (5.5% and 3.9%, respectively).

The distinctive cancer burden within the US Hispanic community likely stems from a variability of risk factors and a comparatively younger age demographic. In 2019, the median age among Hispanic individuals was 30 years, contrasting with the median age of 40 among NHWs. Given that certain cancers, such as prostate, typically manifest at an older age, it is expected lower rates will be observed in a relatively younger population. Conversely, testis cancer, which often occurs in younger men, is anticipated to present at a higher relative rate in a younger population.

Social risk factors also play a role in shaping the overall proportions of GU malignancies. The National Health and Nutrition Examination Survey study found a lower rate of circumcision among Hispanic men compared to NHWs.⁵ Given that circumcision has been linked to a decreased risk of penile cancer, a population with a higher prevalence of foreskin would be expected to show a higher incidence of penile cancer. Additionally, prior research has shown lower rates of cigarette smoking among Hispanic men compared to NHWs and Black men.⁶ Tobacco exposure is a known risk factor for various diseases, particularly bladder malignancy.

US Census Bureau data have shown that Hispanic men are among the highest proportion of individuals without health insurance, with 17.7% uninsured. Disparities in insurance status and limited access to health care may contribute to variations observed in proportions of GU malignancies between Hispanic men and NHWs. Prostate cancer is often diagnosed through PSA screening. If a population is less likely to undergo screening, a discrepancy in observed incidence could be explained by underdiagnosis. Actual incidence may be more similar than diagnoses suggest. Prior studies demonstrating higher rates of metastatic prostate cancer and higher mortality among Hispanic men, despite lower overall incidence, are also suggestive of delayed diagnosis.^2-4

It is crucial to recognize the immense diversity within the US and global Hispanic population, encompassing hundreds of communities, cultures, and nationalities. A notable limitation of our study is the grouping of the Hispanic population as a singular entity. Future endeavors should consider a more nuanced approach, stratifying the Hispanic population based on factors such as nationality, immigration status, socioeconomic status, and level of education to gain deeper insights into the GU malignancy rates and associated risk factors.

Conclusions

Although the US population is 19% Hispanic, Hispanic men represent just 6% of GU malignancies within the NCDB. Hispanic men constituted higher proportions of testicular and penile cancer, and relatively lower proportions of bladder and prostate cancer. These data could contribute to a better understanding of disease epidemiology, morbidity, and mortality associated with GU malignancies in the Hispanic male demographic.