title: Trends in disparate treatment of African American men with localized prostate cancer across National Comprehensive Cancer Network risk groups.
abstract: OBJECTIVE
  To determine whether African Americans (AAs) with intermediate- to high-risk prostate cancer (PCa) receive similar treatment as white patients and whether any observed disparities are narrowing with time.
  
  
  METHODS
  We used Surveillance, Epidemiology, and End Results to identify 128,189 men with localized intermediate- to high-risk PCa (prostate-specific antigen ≥10 ng/mL, Gleason score ≥7, or T stage ≥T2b) diagnosed from 2004 to 2010. We used multivariate logistic regression analyses to determine the impact of race on the receipt of definitive treatment.
  
  
  RESULTS
  AA men were significantly less likely to receive curative-intent treatment than white men (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.79-0.86; P <.001). There was no evidence of this disparity narrowing over time (Pinteraction 2010 vs 2004 = .490). Disparities in the receipt of treatment between AA and white men were significantly larger in high-risk (AOR, 0.60; 95% CI, 0.56-0.64; P <.001) than in intermediate-risk disease (AOR, 0.92; 95% CI, 0.88-0.97; P = .04; Pinteraction <.001). After adjusting for treatment, demographics, and prognostic factors, AA men had a higher risk of prostate cancer-specific mortality (adjusted hazard ratio, 1.12; 95% CI, 1.01-1.25; P = .03).
  
  
  CONCLUSIONS
  AA men with intermediate- to high-risk PCa are less likely to be treated with curative intent than white men. This disparity is worse in high-risk disease and is not improving over time. Factors underlying this treatment disparity should be urgently studied as it is a potentially correctable contributor to excess PCa mortality among AA patients.
authors: Harvard Medical School, Boston, MA.
authors: Brandon A
authors: BA
authors: Mahal
authors: Harvard Radiation Oncology Program, Boston, MA.
authors: Ayal A
authors: AA
authors: Aizer
authors: Harvard Medical School, Boston, MA.
authors: David R
authors: DR
authors: Ziehr
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Andrew S
authors: AS
authors: Hyatt
authors: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
authors: Jesse D
authors: JD
authors: Sammon
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston MA.
authors: Marianne
authors: M
authors: Schmid
authors: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Toni K
authors: TK
authors: Choueiri
authors: Department of Urology, UCLA Medical Center, Los Angeles CA.
authors: Jim C
authors: JC
authors: Hu
authors: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Christopher J
authors: CJ
authors: Sweeney
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Clair J
authors: CJ
authors: Beard
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Anthony V
authors: AV
authors: D'Amico
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Neil E
authors: NE
authors: Martin
authors: Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT.
authors: Simon P
authors: SP
authors: Kim
authors: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston MA.
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: pnguyen@LROC.harvard.edu.
authors: Paul L
authors: PL
authors: Nguyen
mesh_terms: D001741:Black or African American; D000368:Aged; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000628:therapy*; D012307:Risk Factors; D018426:SEER Program; D014481:United States; D044465:White People