The sociodemographics of prostate cancer: risk and category of disease at diagnosis

A study just published suggests that, in the USA, there may be sociodemographic predictors of prostate cancer risk category at presentation — as assessed by serum PSA level, cancer grade, and tumor stage.

Dall’era et al. carried out a retrospective analysis of data from 5,939 patients enrolled in the CaPSURE national disease registry database between 1995 and 2007. Every patient was assigned either to a prostate cancer risk category (low, intermediate, or high) based on diagnostic PSA level, clinical stage, and biopsy Gleason grade or to category that included only men having clinically insignificant disease.

The results of their analysis demonstrated that:

  • Patients who were older, had lower levels of education, and had Medicare with or without a supplement instead of private or Veteran’s Affairs insurance were more likely to have intermediate and high risk disease than low risk disease at time of diagnosis.
  • Non-white race was associated with high risk disease at presentation.
  • Clinically insignificant disease was more common in men < 60 years of age, those with higher education and income, and those with private insurance.
  • Younger age, higher education and income, and private insurance were associated with detection of insignificant disease.
  • Among the men with insignificant disease, younger age and private insurance were associated with immediate treatment with curative intent.

The authors suggest that unique sociodemographic variables are associated with the clinical risk of prostate cancer at diagnosis and that these sociodemographic variables may influence treatment decisions and outcomes. They further state that patients with insignificant disease may be susceptible to overtreatment due to the indolent nature of the disease. Patients who fall into the intermediate and high risk groups, which are associated with poorer outcomes, may be further endangered by late detection of the disease.

While the findings of this analysis may not be entirely surprising, they do confirm what many have suspected, which is that the American health system, with its emphasis on access to health care based on type of health care insurance coverage, tends to over-diagnose and overtreat people with high quality insurance while under-diagnosing and undertreating those who have less generous forms of health insurance.

2 Responses

  1. What is the definition of “clinically insignificant disease” for the purpose of this study?

  2. Allan: The study abstract simply says, “low grade, limited volume tumors.” You’d need to read the full paper to get the details. My best guess is that this would be a patient with a low PSA, a Gleason score of 5 or less, and a tumor volume of less than 0.5 cc … but I am guessing.

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