Of race and definitive treatment after diagnosis of prostate cancer


A new article in Urology (“the Gold Journal”) has again pointed out the race-related discrepancies between the application of definitive treatments for prostate cancer, particularly between Caucasian-American and African-American men.

This article by Moses et al. is based on data from > 300,000 men diagnosed with prostate cancer and listed in the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2011. A commentary on this article also appears in Renal & Urology News.

Moses et al. found that, compared to Caucasian-Americans:

  • African-American men were
    • Less likely to receive definitive treatment overall (odds ratio [OR] = 0.75).
    • Less likely to receive definitive treatment by D’Amico risk classification.
      • For low-risk disease, OR = 0.81
      • For intermediate-risk disease, OR = 0.74
      • For high-risk disease, OR = 0.62
  • Hispanic-American men were
    • Slightly less likely to receive definitive treatment (OR = 0.95).
    • Less likely to receive definitive treatment for higher D’Amico risk classifications.
      • For intermediate-risk disease, OR = 0.89
      • For high-risk disease, OR = 0.79
  • Asian-American men had similar or greater odds of receiving treatment compared to Caucasian-American men within any Gleason or D’Amico classification.

The reasons why we see such different treatment patterns include a wide range of factors that include economics, access to care, other societal factors, and the nature of relationships between the medical community and the African-American community (built up over generations). There are no simple answers to this problem. It is not exclusively a lack of knowledge within the African-American community and it is quite certainly affected by the way health insurance is commonly associated with specific types of occupation and the educational level that must be achieved to obtain such occupation. However, to quote Moses et al.:

Persistent disparities in treatment for [African-American] and emerging disparities in Hispanic men, regardless of stage at presentation, likely represent a significant predictor of higher mortality in underserved populations.

One Response

  1. “Asian-American men had similar or greater odds of receiving treatment compared to Caucasian-American men within any Gleason or D’Amico classification.”

    That’s a very telling conclusion.

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