Impact of socioeconomic status and race on clinical parameters of patients undergoing radical prostatectomy in an equal access health care system

Tarman, Gregory J.; Kane, Christopher J.; Moul, Judd W.; Thrasher, J. Brantley; Foley, John P.; Wilhite, Dayna; Riffenburgh, Robert H.; Amling, Christopher L.

doi:10.1016/s0090-4295(00)00808-6

Cited by 89 publications

(51 citation statements)

References 13 publications

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“…7,8,16 Indeed, in our study, approximately 63% of prostate cancers diagnosed among men of high SES are detected through screening compared with 48% for men of low SES. The results of the current study are consistent with previous studies reporting that men from higher social classes are more likely to be diagnosed with localized disease 8,10,13,27 and that lower SES is associated with a lower likelihood of undergoing PSA testing. 7 Although evidence that prostate cancer deaths are reduced by PSA screening is insufficient, its use may still serve as a marker of delivery of care.…”

Section: Gleason Gradesupporting

confidence: 92%

“…Higher SES has been associated with more frequent PSA screening, 7,8 a lower stage of disease at diagnosis, and better tumor differentiation. 9,10 With regard to prostate cancer survival, results are not always consistent. Previous studies have reported both positive association 10,11 and no association between SES and prostate cancer-specific survival.…”

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confidence: 99%

“…9,10 With regard to prostate cancer survival, results are not always consistent. Previous studies have reported both positive association 10,11 and no association between SES and prostate cancer-specific survival. [12][13][14] Access inequalities to appropriate care and therapy as well as differences in tumor biology are possible explanations for survival differences between SES classes.…”

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confidence: 99%

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Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis

Rapiti

Fioretta

Schaffar

et al. 2009

Cancer

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BACKGROUND: The objective of the current study was to evaluate the impact of socioeconomic disparities on prostate cancer presentation, treatment, and prognosis in Geneva, Switzerland, in which healthcare costs, medical coverage, and life expectancy are considered to be among the highest in the world. METHODS: This population-based study included all patients diagnosed with invasive prostate cancer among the resident population between 1995 and 2005. Patients were divided into 3 socioeconomic groups according to their last known occupation. Compared were patient and tumor characteristics and treatment patterns between socioeconomic groups. Cox multivariate regression analysis was used to assess and explain socioeconomic inequalities in prostate cancer-specific mortality. RESULTS: Compared with patients of high socioeconomic class, those of low socioeconomic class were more often foreigners, were found less frequently to have screen-detected cancer, were found to have a more advanced stage of disease at diagnosis, and less often had information regarding disease characteristics and staging. These patients underwent prostatectomy less frequently and were more often managed with watchful waiting. The risk of dying as a result of prostate cancer (hazards ratio [HR]) in patients of a low versus high socioeconomic status was increased 2-fold (95% confidence interval [95% CI], 1.5-2.6). After adjustment for patient and tumor characteristics and treatment, the mortality risk was no longer found to be significantly increased (HR, 1.2; 95% CI, 0.8-1.6). CONCLUSIONS: In the current study, patients of low socioeconomic class were found to be at increased risk of dying as a result of their prostate cancer. This increased mortality is largely attributable to delayed diagnosis, poor diagnostic workup, and less invasive treatments in these individuals

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Section: Gleason Gradesupporting

confidence: 92%

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confidence: 99%

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confidence: 99%

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Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis

Rapiti

Fioretta

Schaffar

et al. 2009

Cancer

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“…Some did not find race to be an independent risk factor associated with BCR, 9-14 whereas others did identify race as an independent risk factor for BCR. [15][16][17][18] Interestingly, Iselin et al, 10 did not find race to be an independent predictor of BCR in a cohort of patients from our institution 10 years ago. In their study, 77 (9.8%) out of 784 PSA-era patients were African-American.…”

Section: Discussionmentioning

confidence: 62%

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

Schroeck

Sun

Freedland

et al. 2008

Prostate Cancer Prostatic Dis

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We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis. BCR was defined as a PSA of 0.2 ng ml À1 or higher at least 30 days after surgery. A nomogram was developed from the Cox model. Predictive accuracy was obtained by calculating bias-corrected Harrell's c and by bootstrap calibration. In multivariate analysis, PSA (hazard ratio 1.39 (95% confidence interval 1.29-1.51)), ECE (1.22 (1.04-1.44)), pG score (1.38 (1.14-1.68), 2.23 (1.76-2.84), 2.69 (2.12-3.40) for pG 3 þ 4, 4 þ 3, 47, respectively), SVI (1.72 (1.40-2.12)), PSM (2.05 (1.73-2.42)), year of surgery (0.65 (0.54-0.77)), African-American race (1.37 (1.13-1.66)), adjuvant ) and prostate weight (0.83 (0.76-0.92)) were identified as independent predictors of BCR (Pp0.018 for all factors). Predictive accuracy of the nomogram was 0.75. Race and prostate weight were independent predictors for BCR after RP. By incorporating these variables, we developed a nomogram, which provides a highly accurate means for estimating risk of BCR after RP.

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“…In an equal access health-care system (the US military), no difference in prostate cancer outcome is seen between African-American and White men. 1 Although the reasons for observed racial differences may be multi-factorial, poor awareness of the disease and risk may well contribute towards delayed presentation.…”

Section: Introductionmentioning

confidence: 99%

Racial origin is associated with poor awareness of prostate cancer in UK men, but can be increased by simple information

Krishnamoorthy

Chandrasekera

Zhu

et al. 2007

Prostate Cancer Prostatic Dis

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Prostate cancer is the second most common cause of cancer death in UK men. We have shown a higher incidence and disease stage in black British men (unpublished), however there is no evidence regarding their awareness of prostate cancer and screening. We assessed the level of prostate cancer awareness and attitudes in Black and White men in the UK, and to see if written information would modify awareness. Information was collected from two groups of 871 men without prostate cancer using a new, validated, prostate cancer awareness questionnaire. The first group was asked to fill in the questionnaire, whereas the second group was initially given printed information on prostate cancer and requested to fill in the questionnaire. Data were compared between the two ethnic groups using SPSS statistical package. Changes in knowledge and attitudes after providing prostate health education were analysed. There was a significantly lower response from Black men. In the first group, Black men were unaware of their increased risk of developing the disease and demonstrated poor knowledge about the symptoms of prostate cancer (Po0.001) and also more negative attitudes about its control and treatment (Po0.01). In the second group, there were significant improvements in knowledge, risk awareness and attitudes following targeted education: this was true for Black and White men. Although Black British men have a high risk of prostate cancer, their knowledge of the disease is poor. Simple education methods can significantly improve awareness and knowledge in both Black and White men.

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Impact of socioeconomic status and race on clinical parameters of patients undergoing radical prostatectomy in an equal access health care system

Cited by 89 publications

References 13 publications

Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis

Impact of socioeconomic status on prostate cancer diagnosis, treatment, and prognosis

Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy

Racial origin is associated with poor awareness of prostate cancer in UK men, but can be increased by simple information

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