Prostate cancer prevalence in Ohio: Rural–urban differences, environmental toxicity, and correlation with breast cancer incidence.

e22626 Background: Prostate cancer is one of the most common cancers among men worldwide and in the United States. Socioeconomic conditions and environmental exposures play an important role in shaping risk, and inequalities in these factors are linked to differences in survival outcomes. To better characterize this geographic variation in prostate cancer burden in Ohio, we evaluated geographic hotspots of prostate cancer incidence, assessed rural–urban differences, and association between high incidence regions and environmental toxic exposures to aid in the development of targeted public health interventions and prioritization of high-need regions in Ohio. Methods: This retrospective, population-based study analyzed de-identified data from 2018–2025 obtained from the Ohio Cancer Incidence Surveillance System. Following Ohio Department of Health IRB approval and execution of a Data Use Agreement, analyses were conducted at the University of Toledo. County-level toxic release data were obtained from the EPA Toxic Release Inventory. Prostate cancer incidence was analyzed at the ZIP code level using two-way analysis of variance (ANOVA) to assess associations with rural–urban classification (0–4 scale) and environmental toxin release quartiles, with interaction terms evaluating effect modification. Pearson correlation coefficients assessed linear associations between ZIP code–level prostate and breast cancer incidence. Post hoc comparisons were performed using Tukey’s honestly significant difference test, with statistical significance defined as p < 0.05. Results: Two-way ANOVA test demonstrated a marginally significant elevation in prostate cancer rates in ZIP codes located in rural counties.(p = 0.077) . No significant difference was found for environmental toxicity releases ( p = 0.169). No significant interaction effect between geography and toxicity was observed (p = 0.828). However, Pearson’s correlational analysis revealed a strong, and significant positive correlation between regional prostate cancer rates and breast cancer rates (r = 0.848, p < 0.0001). Conclusions: A marginal association was observed between prostate cancer incidence and rurality but no significant association with EPA-tracked toxic chemical releases. Prostate cancer incidence was strongly correlated with breast cancer incidence across regions, suggesting shared geographic or healthcare-related factors. Further investigation into regional screening practices, stage at diagnosis, and healthcare access is warranted to better understand prostate cancer disparities in Ohio. Factor Categories Anova Statistic (F) P value Urban-Rural Classification 0–4 0.00021613 2.13 0.0770 Toxicity level Quartiles (1=lowest 4=highest) 0.00012872 1.69 0.1687 Urban–rural × toxicity interaction Interaction term 0.00014759 0.58 0.8280