Factors contributing to the racial differences in prostate cancer mortality.
OBJECTIVE
To analyse, in a retrospective cohort study, differences in rates of surgical treatment for prostate cancer between African-Americans and White Americans, and to evaluate the extent to which these differences are associated with disparities in survival rates between these groups.


METHODS
Clinical, pathological, and demographic data from 4279 men diagnosed with clinically localized prostate cancer between 1980 and 1997 were used. The variables assessed included age, disease stage, tumour grade, comorbidities, treatment method, and socio-economic status (SES). Kaplan-Meier survival curves were generated and compared using log-rank tests. The Cox proportional hazards method was used for analyses involving adjustments for potential confounding factors.


RESULTS
The surgical treatment rate was 17% for African-American and 28% for White patients (P < 0.001). In those patients treated conservatively or by radiation therapy, both crude and cancer-specific survival rates were lower for African-Americans than for Whites (P < 0.001). However, for patients undergoing surgery, differences in survival between African-Americans and Whites were not statistically significant. According to our models, SES explained 50% and surgical treatment rates approximately 34% of the differences in survival between African-Americans and Whites.


CONCLUSIONS
This analysis suggests that the lower prostate cancer survival rates for the African-Americans in the present population can be largely explained by differences in SES and lower surgical treatment rates. Efforts to increase awareness of treatment options among African-American patients may be a way of improving survival in this group.
Tewari
Ashutosh
A
Vattikuti Urology Institute and Josephine Ford Cancer Center, Henry Ford Health System, Detroit, MI, USA.
Horninger
Wolfgang
W
Pelzer
Alexandre E
AE
Demers
Raymond
R
Crawford
E David
ED
Gamito
Eduard J
EJ
Divine
George
G
Johnson
Christine Cole
CC
Bartsch
George
G
Menon
Mani
M
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002423:Cause of Death; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data