PURPOSE: To evaluate the relationship between age and race on the receipt of definitive therapy among men with high-risk prostate cancer (CaP).
METHODS: We used the Surveillance, Epidemiology and End Results Program to identify 62,644 men with high-risk CaP (PSA >20 or Gleason 8-10 or stage ≥cT3a) diagnosed from 2004 to 2010. Multivariable logistic regression analysis modeled the interaction between age and race and its association with receipt of definitive therapy on 57,674 patients (47,879 white men; 9,795 African American [AA] men) with complete data on the covariates of interest.
RESULTS: Among men age ≥70, AA men had a higher risk of CaP-specific mortality (PCSM) compared to white men after adjusting for sociodemographic and prostate cancer-specific factors (Adjusted HR 1.20; 95% CI 1.02-1.38; P=0.02). Nevertheless, a significant interaction between race and age was found (Pinteraction=0.01), such that the adjusted odds of receiving definitive treatment for AA vs. white was 0.67 (95% CI 0.62-0.73; P< 0.001) among men age < 70, but was 0.60 (95% CI 0.55-0.66; P< 0.001) among men age ≥70, suggesting increased racial disparity in the receipt of definitive treatment among older men.
CONCLUSION: AA men with high-risk CaP are less likely to receive definitive therapy than white men. This disparity is significantly larger among men age ≥70, despite excess PCSM among AA men in this group. With a rapidly expanding population of older minority men, this disparity should be urgently addressed to prevent increasing disparities in cancer care.
Written by:
Mahal BA, Ziehr DR, Aizer AA, Hyatt AS, Lago-Hernandez C, Choueiri TK, Elfiky AA, Hu JC, Sweeney CJ, Beard CJ, D'Amico AV, Martin NE, Kim SP, Lathan CS, Trinh QD, Nguyen PL. Are you the author?
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Harvard Radiation Oncology Program, 75 Francis Street, Boston, MA 02115, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Urology, UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, USA; Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, 20 York Street, North Pavilion 4, New Haven, CT 06510, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Reference: J Geriatr Oncol. 2014 May 23. pii: S1879-4068(14)00069-1.
doi: 10.1016/j.jgo.2014.05.001
PubMed Abstract
PMID: 24862107
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