Racial differences in initial treatment for clinically localized prostate cancer

Hoffman, Richard M.; Harlan, Linda C.; Klabunde, Carrie N.; Gilliland, Frank D.; Stephenson, Robert A.; Hunt, William C.; Potosky, Arnold L.

doi:10.1046/j.1525-1497.2003.21105.x

Cited by 90 publications

(62 citation statements)

References 46 publications

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“…These differences corroborate findings of many studies [17,19]. Researchers have also noted that strong social support may contribute to treatment patterns that influence outcomes [2].…”

Section: Discussionsupporting

confidence: 86%

“…Many studies have found more advanced disease at diagnosis [17], while other studies show poorer survival in AA men compared with other racial groups [1]. Conversely, some studies report no differences in age and clinical stage at diagnosis between AA and Caucasian men in settings of equal access to health care [18] and similar overall mortality rates across racial groups after treatment [19].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Background: African American (AA) men suffer a higher prostate cancer (PCa) burden than other groups. Objective: We aim to determine the impact of race on the risk of upgrading, upstaging, and positive surgical margins (PSM) at radical prostatectomy (RP) among men eligible for active surveillance. Design, setting, and participants: We studied men with low-risk PCa treated with RP at two centers. Low clinical risk was defined by National Comprehensive Cancer Network criteria. Outcome variables were upgrading, upstaging, and PSMs at surgery. Associations between race and the outcomes were evaluated with logistic regression adjusted for age, relationship status, diagnostic prostate-specific antigen level, percentage of positive biopsy cores, surgical approach, year of diagnosis, and clinical site. Results and limitations: Of 9304 men diagnosed with PCa, 4231 were low risk and underwent RP within 1 yr. Men were categorized as AA (n = 273; 6.5%), Caucasian (n = 3771; 89.1%), or other racial/ethnic group (Other; n = 187; 4.4%). AA men had a significantly younger mean age (58.7 yr; standard deviation: AE7.06), and fewer (85%) were married or had a partner. Upgrading (34%) and upstaging (13%) rates did not significantly differ among the groups. The PSM rate was significantly higher in AA men (31%) than in the Caucasian (21%) and Other (20%) groups ( p < 0.01). We found an association between race group and PSM rate ( p < 0.03), with higher odds of PSMs in AA men versus Caucasian men (odds ratio [OR]: 1.64; 95% confidence interval [CI], 1.08-2.47). No statistically significant associations between race and rates of upgrading and upstaging were found. This study was limited by the relatively low proportion of AA men in the cohort. Conclusions: Among clinically low-risk men who underwent RP, AA men had a higher likelihood of PSMs compared with Caucasian men. We did not find statistically significantly different rates of upgrading and upstaging between the race groups. Patient summary: We analyzed two large groups of men with what appeared to be lowrisk prostate cancer based on the initial biopsy findings. The likelihood of finding worse disease (higher grade or stage) at the time of surgery was similar across different racial groups.

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“…These differences corroborate findings of many studies [17,19]. Researchers have also noted that strong social support may contribute to treatment patterns that influence outcomes [2].…”

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…However, other investigators reported racial and ethnic disparities that persist after controlling for socioeconomic factors and access to medical care, and found that most cancer in this population is still detected by screening. 20,21 Patients at SFGH were no older on average than those at UCSF and younger than those in CaPSURE, suggesting that delayed diagnosis due to poor access to care does not likely explain a large part of the risk difference.…”

Section: Resultsmentioning

confidence: 98%

Disproportionate Presentation of High Risk Prostate Cancer in a Safety Net Health System

et al. 2010

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Purpose: Most prostate cancer research is based on relatively homogenous cohorts of men, often with comparatively high socioeconomic status. We describe prostate cancer characteristics in men treated in a public health system and hypothesize a disproportionate burden of high risk disease in this population. Materials and Methods:We created a clinical registry from a review of the medical records of 377 men diagnosed with prostate cancer in the San Francisco General Hospital system, which provides care to underserved, uninsured populations. We compared sociodemographic data and cancer characteristics with those in 2 large prostate cancer databases from a community (CaPSURE™) and an academic (University of California-San Francisco tumor registry) setting to assess differences in risk distribution using the D'Amico and Cancer of the Prostate Risk Assessment scoring systems. Results: Compared to men in CaPSURE or the University of California-San Francisco tumor registry those in the San Francisco General Hospital cohort were nonwhite (76%), insured under Medicaid (31%) or uninsured (8%) and had adverse clinical characteristics, including median prostate specific antigen greater than 10 ng/ml at diagnosis and higher Gleason grade. In addition, the majority of patients (67%) had intermediate or high risk disease based on the D'Amico classification and a higher mean Cancer of the Prostate Risk Assessment score. Using ANOVA for continuous variables and the chi-square test for categorical variables, all comparisons were statistically significant (p Ͻ0.001). Conclusions: Men in the San Francisco General Hospital public health system bear a substantially higher burden of high risk disease that those in an academic or a community setting. Populations such as this would benefit most from targeted efforts for early detection and treatment to decrease prostate cancer morbidity and mortality.

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“…Sexual QOL between Japanese and American men with localized prostate cancer Ethnic comparisons of sexuality after prostate cancer treatment have been limited to studies of non-Hispanic whites, African-Americans, and Hispanics in the US [39]. Disparities in sexual function among Asian men treated for prostate cancer have not been fully explored.…”

Section: Defining Sexual Qol: Validated Instrumentsmentioning

confidence: 99%

Sexual quality of life for localized prostate cancer: a cross‐cultural study between Japanese and American men

Namiki

Arai

2011

Reprod Medicine & Biology

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Introduction Race and ethnicity are important factors in health-related quality of life (QOL) because of racial differences in preferences for, and trust in, health systems. Such factors are likely to affect QOL and patient satisfaction with care. Results Using a self-reported questionnaire, Japanese men with prostate cancer reported lower sexual function scores at baseline. In detail, Japanese men were more likely than American men to report poor sexual desire, poor erection ability, poor overall ability to function sexually, poor ability to attain orgasm, poor quality of erections, infrequency of erections, infrequency of morning erections, and intercourse in the previous 4 weeks. However, Japanese men were less likely than American men to be concerned about their sexual function. Two years after surgery, American patients were more likely than Japanese patients to regain their baseline sexual function. The use of phosphodiesterase-5 (PDE-5) inhibitors has been widely publicized as the solution to erectile dysfunction after prostate cancer treatment. Although PDE-5 inhibitors have been available in Japan since 1999, it is striking that Japanese men with localized prostate cancer are much less likely (only 10%) to use PDE-5 inhibitors than American men. Conclusion Japanese patients with localized prostate cancer report worse sexual function but are less concerned about their reduced function. In the absence of a biological explanation for such differences, however, we suspect that cultural differences may explain the differences between QOL survey results from Japanese or American men with prostate cancer.

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Racial differences in initial treatment for clinically localized prostate cancer

Cited by 90 publications

References 46 publications

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

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

Disproportionate Presentation of High Risk Prostate Cancer in a Safety Net Health System

Sexual quality of life for localized prostate cancer: a cross‐cultural study between Japanese and American men

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