title: Treatment of early-stage prostate cancer among rural and urban patients.
abstract: BACKGROUND
  Geographic barriers and limited availability of cancer specialists may influence early prostate cancer treatment options for rural men. This study compares receipt of different early prostate cancer treatments between rural and urban patients.
  
  
  METHODS
  Using 2004-2006 SEER Limited-Use Data, 51,982 early prostate cancer patients were identified (T1c, T2a, T2b, T2c, T2NOS; no metastases) who were most likely to benefit from definitive treatment (< 75 years old, Gleason score < 8, PSA ≤ 20). Definitive treatment included radical prostatectomy, daily external beam radiation for 5 to 8 weeks, brachytherapy, or combination external beam radiation/brachytherapy. Adjusted definitive treatment rates were calculated by rural-urban residence overall, and for different sociodemographic and cancer characteristics, and different states based on logistic regression analyses, using general estimating equation methods to account for clustering by county.
  
  
  RESULTS
  Adjusted definitive treatment rates were lower for rural (83.7%) than urban (87.1%) patients with early-stage prostate cancer (P ≤ .01). Rural men were more likely than urban men to receive non-definitive surgical treatment and no initial treatment. The lowest definitive treatment rates were among rural subgroups: 70 to 74 years (73.9%), African Americans (75.6%), American Indians/Alaska Natives (77.8%), single/separated/divorced (76.8%), living in New Mexico (69.3%), and living in counties with persistent poverty (79.6%).
  
  
  CONCLUSIONS
  Between 2004 and 2006, this adjusted analysis found that men who were living in rural areas were less likely to receive definitive treatment for their early-stage prostate cancer than those living in urban areas. Certain rural patient groups with prostate cancer need particular attention to ensure their access to appropriate treatment. Rural providers, rural health care systems, and cancer advocacy and support organizations should ensure resources are in place so that the most vulnerable rural groups (men between 60 and 74 years of age; African American men; men who are single, separated, or divorced; and men living in rural New Mexico) can make informed prostate cancer treatment choices based on their preferences.
authors.affiliation: WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington, Seattle, WA 98195-4982, USA. lmb@uw.edu
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: C Holly A
authors.initials: CH
authors.lastname: Andrilla
authors.forename: Michael P
authors.initials: MP
authors.lastname: Porter
authors.forename: Roger A
authors.initials: RA
authors.lastname: Rosenblatt
authors.forename: Shilpen
authors.initials: S
authors.lastname: Patel
authors.forename: Mark P
authors.initials: MP
authors.lastname: Doescher
mesh_terms: D000328:Adult; D000368:Aged; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D018570:Risk Assessment; D012424:Rural Population; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States; D014505:Urban Population
keywords: SEER Program; health care quality, access, and evaluation; prostatic neoplasms; rural population