Impact of Ethnicity on Primary Treatment Choice and Mortality in Men With Prostate Cancer: Data From CaPSURE

Abstract

A B S T R A C T PurposeMen diagnosed with prostate cancer have multiple options available for treatment. Previous reports have indicated a trend of differing modalities of treatment chosen by African American and white men. We investigated the role of ethnicity in primary treatment choice and how this affected overall and cancer-specific mortality. MethodsBy utilizing data abstracted from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), patients were compared by ethnicity, primary treatment, number of comorbidities, risk level according to modified D'Amico criteria, age, highest educational level attained, type of insurance, treatment facility, and perception of general health. Multinomial logistic regression analysis was performed to determine the effect of the tested variables on primary treatment and mortality. ResultsAfrican American men were more likely to receive nonsurgical therapy than white men with equivalent disease characteristics. Whites were 48% less likely than African Americans to receive androgen deprivation therapy (ADT) compared with surgery (P ϭ .02) and were 25% less likely than African Americans to receive radiation therapy compared with surgery (P ϭ .08). Whites with low-risk disease were 71% less likely to receive ADT than African American men with similar disease (P ϭ .01). Adjusted overall and prostate cancer-specific mortality were not significantly different between whites and African Americans (hazard ratios, 0.73 and 0.37, respectively). Risk level, type of treatment, and type of insurance had the strongest effects on risk of mortality. ConclusionThere is a statistically significant difference in primary treatment for prostate cancer between African American and white men with similar risk profiles. Additional research on the influence of patient/physician education and perception and the role that socioeconomic factors play in mortality from prostate cancer may be areas of focus for public health initiatives.

Racial Variation in Prostate Cancer Upgrading and Upstaging Among Men with Low-risk Clinical Characteristics

“…Researchers have also noted that strong social support may contribute to treatment patterns that influence outcomes [2]. Following progression during AS, AA men often forego RP [22] in favor of radiation or another nonsurgical therapy for PCa [23]. Such treatment patterns, together with the referral populations represented by UODB and CaPSURE sites, may explain, in part, the lower representation of AA men in our cohort.…”

Prostate Cancer Registries: Current Status and Future Directions

“…Potential risk factors and prognostic factors can be identified from these data as well [13]. In addition, they might be useful for assessment of trends in the adoption of screening, diagnostic, and treatment procedures, as well as novel technologies [54,56,58,[60][61][62][63][64][65][66][67]. For example, Vickers et al [68] demonstrated that restriction of PSA testing to only young men or selected men aged >70 yr might reduce the risk of overdiagnosis.…”

“…Disparities and variations in the use of imaging and treatment modalities can also be evaluated using diseasespecific registries. In particular, these databases allow examination of the relationship between baseline characteristics and the likelihood of receiving proper staging or adequate treatment [54,56,58,[60][61][62][63][64][65][66][67]. A recent CaPSURE study demonstrated substantial differences in primary treatment between African-American and white men with similar risk profiles [54].…”

“…In addition, tumor registries can provide incidence and mortality data on patients with rare histologic subtypes that are not included in RCTs or institutional cohorts [53]. Cancer registries are also used to examine differences in incidence and mortality rates according to patient characteristics such as age, comorbidity status, race, socioeconomic status, and disease severity [54][55][56][57][58][59]. Potential risk factors and prognostic factors can be identified from these data as well [13].…”

Clinical examination of the male population: the value in the primary detection of prostate cancer at the level of regional health

“…Соглас-но исследованию CaPSURE различные методы лечения РПЖ применяли со следующей частотой: радикальная простатэктомия -54,9 %, лучевая терапия -32,1 %, андрогенная депривация -5,6 %, аблативные методы -5,3 %, активное наблюдение -2,1 % [12].…”