Prostate cancer treatment in southwestern Georgia: race and a rural environment

A new study just published in Urology seems to confirm facts that have previously been identified in earlier studies of how men elect to get treated for localized prostate cancer in parts of the USA with a high proportion of African American residents and relatively low income levels.

Steenland et al. collected and studied data on 516 men from the 33 counties in southwestern Georgia. This is a largely rural community with a total population of about 700,000, and 40 percent of that population is African American. All the men in this study were less than 75 years of age and were diagnosed with apparently localized prostate cancer.

In order to compile sufficient information on this cohort of men, the researchers did the following:

  • Abstracted relevant treatment data from medical records from all 516 patients
  • Conducted interviews with 314/516 patients (60.8 percent)
  • Compared treatments in southwestern Georgia to treatments in the city of Atlanta in 2005

The results of their analysis showed that:

  • The types of treatment most commonly selected by patients in southwestern Georgia during this time frame were
    • External beam radiation therapy + brachytherapy (31 percent)
    • External beam radiation therapy alone (27 percent)
    • Surgery, i.e., radical prostatectomy (18 percent)
  • Patients in southwestern Georgia were more than twice as likely as patients in Atlanta to be treated with external beam radiation as compared to surgery (odds ratio [OR] = 2.66).
  • African American men were twice as likely as white men to select a treatment other than surgery (OR = 2.04).
  • African American men in southwestern Georgia were 3.5 times as likely as white men to select a treatment other than surgery (OR = 3.51).
  • 13 percent of men in southwestern Georgia reported poor communication with their physician.
    • African American men were nearly four times as likely as white men to report  poor communication (OR = 3.95)
    • Men who had no treatment as opposed to some treatment were nearly six times as likely to report poor communication (OR = 5.77).

There are a host of possible reasons for these racial differences in type of treatment in this specific region.

We are struck by the fact that Georgia is perhaps the only state in America where the combination of brachytherapy and external beam radiation therapy is very heavily promoted (as ProstRcision, by RC Cancer Centers). It also occurs to us that the election of radiation therapy as opposed to surgery ensures that the patient never needs to be fully anesthetized, and so is fully conscious at all times during his treatment. (This may be a critical cultural issue given the history of experimentation on African Americans without their knowledge.)

The authors suggest that income differences (as opposed to race) may explain why white men had surgery more often than African Americans. It may well be that insurance coverage (rather than actual income) is a factor because of the likely need for at least one or perhaps two nights of hospitalization associated with surgery as compared to no hospitalization being associated with radiation therapy. However, the abstract of this paper offers no guidance.

We have never seen national data on the percentages of men with prostate cancer who report “poor communication” with their doctors, so whether the 13 percent figure reported in this study is any different from the national average cannot be confirmed. It does seem very possible that 10 to 15 percent of Americans might report “poor communication” in relation to their experiences in seeking treatment for prostate cancer. Indeed, that number may well be higher.

Is there a key takeaway from this study? That is hard to know. There is good reason to believe that, from an oncologic outcome viewpoint, the forms of therapy being selected might have roughly similar outcomes over time. Whether there are significant differences in quality of life after these various treatment is harder to tie down.

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