Geographic and socioeconomic variation in the treatment of prostate cancer.
OBJECTIVE
Within a framework of quality assessment, primary treatment choice constitutes an indicator of quality of care. This study examines geographic and socioeconomic variation in the primary treatment of men with prostate cancer during the era of prostate-specific antigen testing.


METHODS
Using the National Cancer Institute's Surveillance, Epidemiology, and End Results public use data files, we identified men with localized/regional prostate cancer who underwent surgery, radiation therapy, or watchful waiting. We used the year 2000 US Census information to ascribe education and income levels to these men based on their county of residence and ethnicity.


RESULTS
Among the 96,769 men with localized/regional prostate cancer (during 1995 to 1999) who had sufficient information for analysis, we observed significant geographic variation nationwide in surgical, radiation, and watchful waiting treatment rates (P <.0015). Patterns noted 10 years ago, such as higher surgical rates in western regions, persisted. Ethnicity, income, and grade were all independently associated with primary treatment, or lack thereof. Blacks and low-income patients had the lowest rates of surgery and radiation. Grade was the best predictor of aggressive treatment.


CONCLUSIONS
Nonclinical factors, such as ethnicity and income, were associated with the use of watchful waiting rather than surgery or radiation in men with early-stage prostate cancer. These findings have implications for quality of care.
Krupski
Tracey L
TL
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, USA. krups001E@mc.duke.edu
Kwan
Lorna
L
Afifi
Abdelmonem A
AA
Litwin
Mark S
MS
D000368:Aged; D005006:Ethnicity; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000191:economics* / Q000208:ethnology / Q000628:therapy*; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D018426:SEER Program / Q000706:statistics & numerical data; D012923:Social Class; D012959:Socioeconomic Factors
D017430:Prostate-Specific Antigen