title: Current clinical presentation and treatment of localized prostate cancer in the United States.
abstract: OBJECTIVE
  SEER recently released patient Gleason scores at biopsy/transurethral resection of the prostate. For the first time this permits accurate assessment of prostate cancer presentation and treatment according to clinical factors at diagnosis.
  
  
  METHODS
  We used the SEER database to identify men diagnosed with localized prostate cancer in 2010 who were assigned NCCN(®) risk based on clinical factors. We identified sociodemographic factors associated with high risk disease and analyzed the impact of these factors along with NCCN risk on local treatment.
  
  
  RESULTS
  Of the 42,403 men identified disease was high, intermediate and low risk in 38%, 40% and 22%, respectively. On multivariate analysis patients who were older, nonwhite, unmarried or living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease (each p <0.05). Of the 38,634 men in whom prostate cancer was the first malignancy 23% underwent no local treatment, 40% were treated with prostatectomy, 36% received radiation therapy and 1% underwent local tumor destruction, predominantly cryotherapy. On multivariate analysis patients who were older, black, unmarried or living in a county with a higher poverty rate, or who had low risk disease were less likely to receive local treatment (each p <0.05).
  
  
  CONCLUSIONS
  Our analysis provides information on the current clinical presentation and treatment of localized prostate cancer in the United States. Nonwhite and older men living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease and less likely to receive local treatment.
authors.affiliation: Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts. Electronic address: umahmood@mdanderson.org.
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Levy
authors.affiliation: Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Lee
authors.affiliation: Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.affiliation: Departments of Radiation Oncology, M.D. Anderson Cancer Center, Houston, Texas, and Brigham and Women's Hospital, Harvard Medical School (PLN), Boston, Massachusetts.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D012959:Socioeconomic Factors; D014481:United States
keywords: healthcare disparities; neoplasm grading; prostate; prostatic neoplasms; risk