Developing a polysocial risk score for prostate cancer patients treated with radical prostatectomy

Introduction: Prostate cancer is the leading cause of cancer morbidity and mortality among men in the United States, with stark racial disparities. Black men experience both higher incidence and worse outcomes compared to White men, even after accounting for clinical stage and treatment. Social determinants of health (SDOH) are increasingly recognized as critical drivers of these disparities, influencing care across the prostate cancer continuum-from screening to survivorship. We developed a novel polysocial risk score that integrates multiple psychosocial and socioeconomic factors to quantify cumulative SDOH burden, and evaluated its associations with race, clinical characteristics, and neighborhood context in a prostate cancer cohort. Methods: We retrospectively identified 126 prostate cancer patients who underwent radical prostatectomy between 2011 and 2019 at a single academic cancer center. Eleven candidate variables-capturing perceived stress, loneliness, financial strain, and socioeconomic status (education, income, employment)-were included in an exploratory factor analysis. A 7-item unidimensional composite (1 stress item, 3 loneliness items, 1 financial strain item, 2 SES items) was retained based on factor loadings and showed acceptable internal consistency (Cronbach's alpha = 0.74). We compared polysocial risk scores by self-reported race (Black vs. White) and examined associations with tumor stage, prostate-specific antigen (PSA), the Social Deprivation Index (SDI), and neighborhood collective efficacy. Results: The final score accounted for 39.6% of variance in the item set, reflecting a cohesive social risk construct. Black patients had significantly higher scores than White patients (mean 2.79 vs. -1.08, p < .001), indicating greater cumulative social adversity. The score was not associated with tumor stage (p = .89), suggesting social risk burden was independent of disease severity. However, higher scores were correlated with neighborhood disadvantage (SDI, r = 0.52, p < .001) and lower collective efficacy (trust; r = -0.20, p = .03). Conclusion: This composite measure of psychosocial and socioeconomic adversity revealed markedly higher cumulative social risk among Black prostate cancer patients, despite similar clinical profiles. The polysocial risk score may aid in identifying patients with unmet social needs who could benefit from targeted supportive interventions. Integrating social risk assessment into prostate cancer care may promote health equity by addressing upstream determinants of disparate outcomes.