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Understanding Urban-Rural Disparities in Prostate Cancer Treatment

August 18, 2020

Bruce L Jacobs MD MPHSocial determinants of health, such as geographic location, race, ethnicity, and socioeconomic status, can pose a barrier to health care. Recent research1 conducted by Bruce L. Jacobs, MD, MPH, assistant professor of Urology in the Department of Urology at the University of Pittsburgh School of Medicine, has uncovered gaps in the treatment of prostate cancer between urban and rural residents. 

Dr. Jacobs and Department colleague Benjamin J. Davies, MD, along with collaborators from the University of Pittsburgh Graduate School of Public Health, published their findings in January in The Journal of Urology.

Using the Pennsylvania Cancer Registry, Dr. Jacobs’ and colleagues identified more than 50,000 men in Pennsylvania diagnosed with prostate cancer between 2009 and 2015. Patients were classified as residing in a rural area, a large town, or an urban location.

The primary finding of the study showed that, compared to urban residents, individuals who lived in rural areas were less likely to receive treatment for their disease, regardless of their disease characteristics. This was most pronounced for patients with high-risk disease.

“Living in an urban or rural location is associated with the type of prostate cancer treatment patients receive,” says Dr. Jacobs. “The lack of treatment for rural residents with high-risk disease is problematic because these are patients who potentially could benefit most from treatment.” 

More About Dr. Jacobs

Bruce L. Jacobs, MD, MPH, is fellowship-trained in urologic oncology, laparoscopy, and endourology. He also completed a fellowship in health services research during his urologic training at the University of Michigan before joining the UPMC Department of Urology as an assistant professor in 2013. While at the University of Michigan, Dr. Jacobs earned his master’s in public health (MPH) with a concentration in epidemiology.

Dr. Jacobs’ training and clinical practice have culminated in a career that focuses on improving access to urologic cancer care. Much of his research has focused on prostate cancer, with a particular emphasis on the adoption of new treatment technologies and how they influence clinical outcomes and health policy decisions.2 Dr. Jacobs’ research also has examined readmissions after major surgical procedures in order to develop practices to improve care and reduce readmissions.3


1. Maganty A, Sabik LM, Sun Z, Eom KY, Li J, Davies BJ, Jacobs BL. Under Treatment of Prostate Cancer in Rural Locations. J Urology. 2019; 203: 108-114.

2. Jacobs BL, Yabes JG, Lopa SH, et al. The Influence of Stereotactic Body Radiation Therapy Adoption on Prostate Cancer Treatment Patterns. J Urol. 2020; 203(1): 128-136.

3. Krishnan N, Liu X, Lavieri MS, et al. A Model to Optimize Follow-up Care and Reduce
Hospital Readmissions After Radical Cystectomy. J Urol. 2016; 195(5): 1362-1367.

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