Background/Aims: We determined if differences existed in prostate cancer treatment received by Caucasian and African-American men who had local or biochemical recurrence following radical prostatectomy (RP) for prostate cancer at an HMO where access to medical care is theoretically equal for all members.
We used data collected for a population-based case-control study designed to evaluate the role of specific molecular markers in prostate cancer survival. The subjects were diagnosed with prostate cancer from 1971 through 2001.
Methods: Study subjects were members of one of three health plans: Kaiser Permanente Northwest (KPNW), Kaiser Permanente Southern California (KPSC), or Kaiser Permanente Northern California (KPNC). The study population included 90 African-American and 233 Caucasian men with prostate cancer who had either local or biochemical recurrence following RP. We compared the likelihood, according to race, of treatment with salvage radiation therapy with curative intent (SRT) among these subjects. We reviewed medical records of all subjects to determine all treatment received in addition to RP and to assess potential confounding factors and effect modifiers.
Results: After adjusting for case/control status, institution, age at diagnosis, year of diagnosis, Gleason grade (all matching criteria in the original study), tumor stage, comorbid conditions, presence of positive margins, seminal vesicle involvement or perineural invasion at RP, age at recurrence, year of recurrence, time to recurrence, and intensity of follow-up, Caucasian men were more likely than African-American men to receive SRT in this study population (OR 1.5; 95% CI 0.7-3.1). However, this difference did not reach statistical significance. The factors that did predict for receipt of SRT were the absence of comorbid conditions (OR 2.1; 95% CI 1.1-4.2), recurrence prior to 1994 (OR 2.8; 95% CI 1.4-5.6), and local (rather than biochemical) recurrence (OR 6.9; 95% CI 2.6-18.6).
Conclusions: Although the difference in receipt of SRT between Caucasian and African-American men was not statistically significant, the point estimate suggests that Caucasian men were about 50% more likely to receive it. It is possible that this is a real difference, and that a study with a larger sample size would show that.
Written by:
Richert-Boe K, Haque R, Van Den Eeden S, Weinmann S, Kallakury B. Are you the author?
Reference: Clin Med Res. 2013 Sep;11(3):133-4.
doi: 10.3121/cmr.2013.1176.ps1-61
PubMed Abstract
PMID: 24085890
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