Marriage and ethnicity predict treatment in localized prostate carcinoma.
BACKGROUND
Primary treatment for early-stage prostate carcinoma includes expectant management or, for curative intent, radical prostatectomy or radiotherapy. Treatment recommendations are generally guided by clinical factors such as Gleason grade, prostate-specific antigen level, comorbid illnesses, and patient age. Sociocultural factors may also have influences on patient and urologist treatment choices.


METHODS
The authors used bivariate and multinomial logistic regression to identify medical and sociodemographic predictors of prostatectomy (compared with radiotherapy) and curative therapy (compared with expectant management) in a cohort of 27,920 non-Latino white, black, and Latino men without comorbidities in the latest linked Surveillance, Epidemiology and End Results-Medicare dataset (years 1995-1999). Predictors included tumor stage, patient age, marital status, race/ethnicity, and socioeconomic status.


RESULTS
Younger age and higher tumor grade were robust predictors of curative treatment compared with expectant management and of prostatectomy compared with radiotherapy. Sociodemographic factors had an additive role in treatment choice. Marriage predicted curative treatment compared with expectant management (adjusted risk ratio [RR] = 1.28 [1.25-1.30]) and prostatectomy compared with radiotherapy (adjusted RR = 1.24 [1.20-1.28]). Although blacks and Latinos were just as likely as whites to receive curative treatment, blacks were significantly less likely, whereas Latinos were more likely, to receive prostatectomy compared with radiotherapy (adjusted RRs = 0.77 [0.72-83]) and 1.24 [1.18-1.30], respectively).


CONCLUSIONS
Marriage was positively associated with curative treatment in general, and with prostatectomy specifically. Blacks received prostatectomy less often than whites, although they did not receive less curative treatment overall. Latinos received prostatectomy more often than whites. Clinicians should recognize the importance of cultural and social forces as well as biomedical factors in decisions regarding the treatment of patients with early-stage prostate carcinoma.
Denberg
Thomas D
TD
Division of General Internal Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. tom.denberg@uchsc.edu
Beaty
Brenda L
BL
Kim
Fernando J
FJ
Steiner
John F
JF
D001741:Black or African American; D017677:Age Distribution; D000368:Aged; D001918:Brachytherapy; D015331:Cohort Studies; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D017533:Marital Status; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000601:surgery / Q000628:therapy*; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People