Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter?
OBJECTIVE
To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer (PCa) among the various racial groups in the United States exist, which may be a source of potential disparity in outcome.


METHODS
Utilizing Surveillance, Epidemiology and End Results 17, we identified 327,636 men diagnosed with PCa from 2004 to 2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity.


RESULTS
African American (AA) and Hispanic men were less likely to receive treatment compared to White men (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.71, 0.75, and OR 0.95, 95% CI 0.92, 0.98, respectively). AA men had significantly lower OR of receiving definitive treatment within each D'Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (low-risk OR 0.81, 95% CI 0.78, 0.85; intermediate-risk OR 0.74, 95% CI 0.71, 0.77; and high-risk OR 0.62, 95% CI 0.58, 0.66). Hispanic men with intermediate-risk (OR 0.89, 95% CI 0.84, 0.94) or high-risk (OR 0.79, 95% CI 0.72, 0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D'Amico classification.


CONCLUSIONS
There is a significant disparity in the receipt of treatment for PCa among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer PCa-related outcomes in these populations.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: kelvin.a.moses@vanderbilt.edu.
Kelvin A
KA
Moses
Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY.
Heather
H
Orom
Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY.
Alicia
A
Brasel
Stritch School of Medicine, Loyola University Chicago, Chicago, IL.
Jacquelyne
J
Gaddy
Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Willie
W
Underwood
D005006:Ethnicity; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
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