Abstract C039: Evaluation of allostatic load and urinary surrogate markers as biomarkers of stress in prostate cancer patients

Abstract Prostate cancer outcomes are influenced by social and biological determinants, including chronic stress exposure. However, few studies have examined the combined impact of neighborhood environment and chronic stress on lethal prostate cancer. This study investigates the association of chronic stress—measured via allostatic load and urinary stress metabolites—and neighborhood deprivation with metastasis risk and survival in African American and European American men. Markers indicative of allostatic load were abstracted from clinical records and compiled into a single allostatic load variable following established protocols in a cohort of 828 men with prostate cancer. Additionally, urinary stress metabolites (cortisol, epinephrine, norepinephrine, metanephrine, normetanephrine) were measured using LC-MS, and standardized concentrations were calculated. Neighborhood deprivation was assessed using 2010 Census Tract data, while metastasis risk was determined using NCCN-defined prostate cancer risk scores. Cause of death was identified via the National Death Index through December 31, 2020. Survival time was calculated from diagnosis to death or censoring at December 31, 2020. We examined associations between allostatic load and stress markers and NCCN-defined prostate cancer risk categories (low, intermediate, high/very high, regional/metastatic) using multinomial logistic regression, adjusting for key covariates. Stratified analyses were conducted by self-identified race. Additionally, we performed Cox proportional hazards regression to estimate relative risks for both all-cause and prostate cancer-specific mortality. Our findings showed that higher allostatic load was associated with increased risk of regional/metastatic prostate cancer and with worse overall cancer survival. Upon examining individual stress markers, we found that higher levels of epinephrine were significantly associated with an increased risk of regional/metastatic disease among African American men. Additionally, higher epinephrine levels were significantly associated with prostate cancer-specific mortality. These findings suggest that while allostatic load may reflect chronic stress and its contribution to prostate cancer progression—particularly in African American men—it may also capture the burden of broader comorbidities. Importantly, our results indicate that individual stress biomarkers, especially epinephrine, were more strongly associated with prostate cancer-specific mortality than allostatic load, highlighting the potential value of specific stress markers in understanding and predicting lethal prostate cancer outcomes. Citation Format: Ashlie M. Santaliz Casiano, Catherine Pichardo, Jamirah Chevrin, Tiffany Dorsey, Dax Patel, Stefan Ambs. Evaluation of allostatic load and urinary surrogate markers as biomarkers of stress in prostate cancer patients [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C039.