Racial Variation in Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer: Results from the CEASAR Study.
Relatively little is known about the relationship between race/ethnicity and patient-reported outcomes after contemporary treatments for localized prostate cancer.



To test the hypothesis that treatment-related changes in urinary, bowel, sexual, and hormonal function vary by race/ethnicity.



The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study that enrolled 3708 men diagnosed with localized prostate cancer in 2011-2012.



Patient-reported disease-specific function was measured using the 26-item Expanded Prostate Index Composite (EPIC) at baseline and 6 and 12 mo after enrollment. Mean treatment differences in function were compared by race using risk-adjusted generalized estimating equations.



While all race/ethnic groups reported considerable declines in scores for urinary incontinence after radical prostatectomy (RP) when compared to active surveillance, African-American men reported a greater difference than white men did (adjusted difference-in-differences 8.4 points, 95% confidence interval 2.0-14.8; p=0.01). No difference in bother scores was noted and the overall proportion of explained variation attributable to race/ethnicity was relatively small in comparison to primary treatment and baseline function. No clinically significant racial variation was noted for the sexual, bowel, irritative voiding, or hormone domains. Limitations include the lack of well-established thresholds for clinical significance using the EPIC instrument.



While these data demonstrate that incontinence at 1 yr after RP may be worse for African-American compared to white men, the difference appears to be modest overall. Treatment selection and baseline function explain a much greater proportion of the variation in function after treatment.



We observed that the effect of treatment for prostate cancer on patient-reported function did not vary dramatically by race/ethnicity. Compared to white men, African-American men experienced a somewhat more pronounced decline in urinary continence after radical prostatectomy, but the corresponding changes in bother scores were not significantly different between the two groups.
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: mark.tyson@vanderbilt.edu.
Mark D
MD
Tyson
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
JoAnn
J
Alvarez
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
Tatsuki
T
Koyama
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Karen E
KE
Hoffman
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA.
Matthew J
MJ
Resnick
School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Xiao-Cheng
XC
Wu
Department of Urology, University of California, San Francisco Medical Center, San Francisco, CA, USA.
Matthew R
MR
Cooperberg
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Michael
M
Goodman
Center for Health Policy Research and Department of Medicine, University of California, Irvine, CA, USA.
Sheldon
S
Greenfield
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Ann S
AS
Hamilton
Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
Mia
M
Hashibe
Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
Lisa E
LE
Paddock
Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA.
Antoinette
A
Stroup
School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Vivien W
VW
Chen
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA.
David F
DF
Penson
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Daniel A
DA
Barocas
D001741:Black or African American; D000368:Aged; D057186:Comparative Effectiveness Research; D005767:Gastrointestinal Diseases / Q000208:ethnology / Q000503:physiopathology; D006630:Hispanic or Latino; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012725:Sexual Behavior / Q000208:ethnology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000208:ethnology / Q000503:physiopathology; D014554:Urination; D044465:White People
Active surveillance; Comparative effectiveness; Patient-reported function; Prostate cancer; Radiation; Surgery