Abstract
OBJECTIVE: We examined whether there were racial differences in initial treatment for clinically localized prostate cancer and investigated whether demographic, socioeconomic, clinical, or tumor characteristics could explain any racial differences.
DESIGN: Prospective cohort study.
SETTING: Population-based tumor registries in Connecticut, Los Angeles, and Atlanta.
PARTICIPANTS: We evaluated 1144 African-American and non-Hispanic white men, aged 50 to 74 years, with clinically localized cancer diagnosed between October 1994 and October 1995.
MEASUREMENTS AND MAIN RESULTS: We obtained demographic, socioeconomic, and clinical data from patient surveys and medical record abstractions. We reported adjusted percentages for receiving treatment derived from multinomial logistic regression. We found an interaction between race and tumor aggressiveness. Among men with more aggressive cancers (PSA≥20 ng/mL or Gleason score ≥8), African Americans were less likely to undergo radical prostatectomy than non-Hispanic whites (35.2% vs 52.0%), but more likely to receive conservative management (38.9% vs 16.3%, P=.003). Among the 71% of subjects with less aggressive cancers, African Americans and non-Hispanic whites were equally likely to receive either radical prostatectomy or radiation therapy (80.0% vs 84.5%, P=.2).
CONCLUSIONS: African Americans with more aggressive cancers were less likely to undergo radical prostatectomy and more likely to be treated conservatively. These treatment differences may reflect African Americans’ greater likelihood for presenting with pathologically advanced cancer for which surgery has limited effectiveness. Among men with less aggressive cancers—the majority of cases—there were no racial differences in undergoing radical prostatectomy or radiation therapy.
Similar content being viewed by others
References
Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1973–99. Bethesda, MD: National Cancer Institute; 2002.
Morton RA, Jr. Racial differences in adenocarcinoma of the prostate in North American men. Urology. 1994;44:637–45.
Brawn PN, Johnson EH, Kuhl DL, et al. Stage at presentation and survival of white and black patients with prostate carcinoma. Cancer. 1993;71:2569–73.
Optenberg SA, Thompson IM, Friedrichs P, Wojcik B, Stein CR, Kramer B. Race, treatment, and long-term survival from prostate cancer in an equal-access medical care delivery system. JAMA. 1995;274:1599–605.
Powell IJ, Schwartz K, Hussain M. Removal of the financial barrier to health care: does it impact on prostate cancer at presentation and survival? A comparative study between black and white men in a Veterans Affairs system. Urology. 1995;46:825–30.
Ragland KE, Selvin S, Merrill DW. Black-white differences in stage-specific cancer survival: analysis of seven selected sites. Am J Epidemiol. 1991;133:672–82.
Merrill RM, Brawley OW. Prostate cancer incidence and mortality rates among white and black men. Epidemiology. 1997;8:126–31.
Fowler FJ, Jr, McNaughton Collins M, Albertsen PC, Zietman A, Elliott DB, Barry MJ. Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer. JAMA. 2000;283:3217–22.
Lu-Yao GL, Friedman M, Yao SL. Use of radical prostatectomy among Medicare beneficiaries before and after the introduction of prostate specific antigen testing. J Urol. 1997;157:2219–22.
Mettlin C. Changes in patterns of prostate cancer care in the United States: results of American College of Surgeons Commission on Cancer Studies, 1974–93. Prostate. 1997;32:221–6.
Harlan L, Brawley O, Pommerenke F, Wali P, Kramer B. Geographic, age, and racial variation in the treatment of local/regional carcinoma of the prostate. J Clin Oncol. 1995;13:93–100.
Schapira MM, McAuliffe TL, Nattinger AB. Treatment of localized prostate cancer in African-American compared with Caucasian men. Less use of aggressive therapy for comparable disease. Med Care. 1995;33:1079–88.
Klabunde CN, Potosky AL, Harlan LC, Kramer BS. Trends and black/white differences in treatment for nonmetastatic prostate cancer. Med Care. 1998;36:1337–48.
Quinlan DM, Epstein JI, Carter BS, Walsh PC. Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J Urol. 1991;145:998–1002.
Horwitz EM, Hanks GE. External beam radiation therapy for prostate cancer. CA Cancer J Clin. 2000;50:349–75.
Potosky AL, Harlan LC, Stanford JL, et al. Prostate cancer practice patterns and quality of life: the Prostate Cancer Outcomes Study. J Natl Cancer Inst. 1999;91:1719–24.
Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality of life measure. Med Care. 1998;36:1002–12.
Talcott JA, Rieker P, Clark JA, et al. Patient-reported symptoms after primary therapy for early prostate cancer: results of a prospective cohort study. J Clin Oncol. 1998;16:275–83.
Fowler FJ, Jr, Barry MJ, Lu-Yao G, Roman A, Wasson J, Wennberg JE. Patient-reported complications and follow-up treatment after radical prostatectomy. The Natliona Medicare Experience: 1988–1990 (Updated June 1993). Urology. 1993;42:622–9.
Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–83.
American Joint Committee on Cancer. Prostate. In: Bears OH, Henson DE, Hutter RVP, Kennedy BJ, eds. AJCC Cancer Staging Manual, 5th edn. Philadelphia, PA: Lippincott-Raven; 1997:219–24.
Partin AW, Kattan MW, Subong EN, et al. Combination of prostatespecific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer. A multi-institutional update. JAMA. 1997;277:1445–51.
Graubard BI, Korn EL. Predictive margins with survey data. Biometrics. 1999;55:652–9.
Shah BV, Barnwell BG, Bieler GS. SUDAAN User’s Manual, Release 7.5. Research Triangle Park, NC: Research Triangle Institute; 1997.
Catalona WJ. Management of cancer of the prostate. N Engl J Med. 1994;331:996–1004.
Demark-Wahnefried W, Schildkraut JM, Iselin CE, et al. Treatment options, selection, and satisfaction among African American and white men with prostate carcinoma in North Carolina. Cancer. 1998;83:320–30.
Shaw M, Elterman L, Rubenstein M, McKiel CF, Guinan P. Changes in radical prostatectomy and radiation therapy rates for African Americans and whites. J Natl Med Assoc. 2000;92:281–4.
Robbins AS, Whittemore AS, Van Den Eeden SK. Race, prostate cancer survival, and membership in a large health maintenance organization. J Natl Cancer Inst. 1998;90:986–90.
Desch CE, Penberthy L, Newschaffer CJ, et al. Factors that determine the treatment for local and regional prostate cancer. Med Care. 1996;34:152–62.
Jones GW, Mettlin C, Murphy GP, et al. Patterns of care for carcinoma of the prostate gland: results of a national survey of 1984 and 1990. J Am Coll Surg. 1995;180:545–54.
Mettlin CJ, Murphy GP, Cunningham MP, Menck HR. The National Cancer Data Base report on race, age, and region variations in prostate cancer treatment. Cancer. 1997;80:1261–6.
Yan Y, Carvalhal GF, Catalona WJ, Young JD. Primary treatment choices for men with clinically localized prostate carcinoma detected by screening. Cancer. 2000;88:1122–30.
Polednak AP, Flannery JT. Black versus white racial differences in clinical stage at diagnosis and treatment of prostatic cancer in Connecticut. Cancer. 1992;70:2152–8.
Polednak AP. Prostate cancer treatment in black and white men: the need to consider both stage at diagnosis and socioeconomic status. J Natl Med Assoc. 1998;90:101–4.
Fowler JE, Jr, Bigler SA, Bowman G, Kilambi NK. Race and cause specific survival with prostate cancer: influence of clinical stage, Gleason score, age and treatment. J Urol. 2000;163:137–42.
Imperato PJ, Nenner RP, Will TO. Radical prostatectomy: lower rates among African-American men. J Natl Med Assoc. 1996;88:589–94.
Morris CR, Snipes KP, Schlag R, Wright WE. Sociodemographic factors associated with prostatectomy utilization and concordance with the physician data query for prostate cancer (United States). Cancer Causes Control. 1999;10:503–11.
Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. 2002;94:334–57.
Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;341:1198–205.
Epstein AM, Ayanian JZ, Keogh JH, et al. Racial disparities in access to renal transplantation—clinically appropriate or due to underuse or overuse? N Engl J Med. 2000;343:1537–44.
Ayanian JZ, Cleary PD, Weissman JS, Esptein AM. The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med. 1999;341:1661–9.
Canto JG, Allison JJ, Kiefe CI, et al. Relation of race and sex to the use of reperfusion therapy in Medicare beneficiaries with acute myocardial infarction. N Engl J Med. 2000;342:1094–100.
Barry MJ. Prostate-specific-antigen testing for early diagnosis of prostate cancer. N Engl J Med. 2001;344:1373–7.
Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002;347:781–9.
Legler J, Potosky AL, Gilliland FD, Eley JW, Stanford JL. Validation study of retrospective recall of disease-targeted function: results from the prostate cancer outcomes study. Med Care. 2000;38:847–57.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by Public Health Services contracts N01PC67007, N01CN67009, N01PC67010, N01PC67006, N01PC67005, and N01PC67000 from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services, and by the New Mexico VA Health Care System, Albuquerque, NM.
Rights and permissions
About this article
Cite this article
Hoffman, R.M., Harlan, L.C., Klabunde, C.N. et al. Racial differences in initial treatment for clinically localized prostate cancer. J GEN INTERN MED 18, 845–853 (2003). https://doi.org/10.1046/j.1525-1497.2003.21105.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2003.21105.x