Abstract
Objective
To examine whether racial disparities in survival exist among black, Hispanic, and
Asian patients compared with white patients with clinically localized prostate cancer
(CLPC) after adjustment for the effects of treatment.
Patients and Methods
We performed a retrospective cohort study of patients with CLPC diagnosed from January
1, 1995, through December 31, 2003, as documented in the Surveillance, Epidemiology,
and End Results registry. Treatment-stratified, risk-adjusted Cox proportional hazards
models were constructed.
Results
During the study period, CLPC was diagnosed in 294,160 patients. Of these patients,
123,850 (42.1%) underwent surgery and 101,627 (34.5%) underwent radiotherapy, whereas
68,683 (23.3%) received no treatment. Overall 5-year and 10-year survival rates for
Asians (85.6% and 67.6%, respectively), Hispanics (85.9% and 69.0%, respectively),
and whites (83.9% and 65.7%, respectively) were higher than for blacks (81.5% and
61.7%, respectively) (P<.001). Prostate cancer–specific survival also varied significantly by race (P<.001). A risk-adjusted model stratified by primary treatment modality revealed that
blacks had worse overall survival than whites (hazard ratio, 1.37; 95% CI, 1.33-1.41;
P<.001), whereas Asians had better survival compared with whites (hazard ratio, 0.79;
95% CI, 0.76-0.83; P<.001). After the effects of treatment were accounted for, Hispanics had similar overall
survival compared with whites (hazard ratio, 0.97; 95% CI, 0.94-1.01; P=.10).
Conclusion
Blacks with CLPC have poorer survival than whites, whereas Asians have better survival,
even after risk adjustment and stratification by treatment. These data may be relevant
to US regions with large underserved populations that have limited access to health
care.
Abbreviations and Acronyms:
ADT (androgen-deprivation therapy), CLPC (clinically localized prostate cancer), HR (hazard ratio), SEER (Surveillance, Epidemiology, and End Results)To read this article in full you will need to make a payment
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References
- Global cancer statistics [published correction appears in CA Cancer J Clin. 2011;61(2):134].CA Cancer J Clin. 2011; 61: 69-90
- Multivitamins in the prevention of cancer in men: the Physicians' Health Study II randomized controlled trial.JAMA. 2012; 308: 1871-1880
- Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer.J Natl Cancer Inst. 2003; 95: 1702-1710
American Cancer Society. Cancer facts and figures 2008. http://www.cancer.org/acs/groups/content/@nho/documents/document/2008cafffinalsecuredpdf.pdf. Accessed June 1, 2013.
National Cancer Institute. Surveillance, Epidemiology and End Results (SEER) Program. www.seer.cancer.gov. Accessed June 1, 2013.
National Cancer Institute. SEER*Stat software: version 8.0.2. February 19, 2013. Seer.cancer.gov/seersat. Accessed June 1, 2013.
- Racial/ethnic disparities in access to care and survival for patients with early-stage hepatocellular carcinoma.Arch Surg. 2010; 145: 1158-1163
- Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort.Cancer. 2006; 106: 1276-1285
- Stage at diagnosis and survival in a multiethnic cohort of prostate cancer patients.Am J Public Health. 2003; 93: 1753-1759
- Poor survival for US Pacific Islander cancer patients: evidence from the Surveillance, Epidemiology, and End Results database: 1991 to 2004.J Clin Oncol. 2007; 25: 5738-5741
- Effect of age and race on the survival of men with prostate cancer in the Metropolitan Detroit tricounty area, 1973 to 1987.Urology. 1995; 45: 93-101
- Survival differences among Asian subpopulations in the United States after prostate, colorectal, breast, and cervical carcinomas.Cancer. 2002; 94: 1175-1182
- Differences in prognostic factors and survival among white and Asian men with prostate cancer, California, 1995-2004.Cancer. 2007; 110: 1255-1263
- Differences in socioeconomic status and survival among white and black men with prostate cancer.Am J Epidemiol. 2000; 151: 409-416
- Association of African-American ethnic background with survival in men with metastatic prostate cancer.J Natl Cancer Inst. 2001; 93: 219-225
- Race, prostate cancer survival, and membership in a large health maintenance organization.J Natl Cancer Inst. 1998; 90: 986-990
- Removal of the financial barrier to health care: does it impact on prostate cancer at presentation and survival? a comparative study between black and white men in a Veterans Affairs system.Urology. 1995; 46: 825-830
- Impact of socioeconomic status and race on clinical parameters of patients undergoing radical prostatectomy in an equal access health care system.Urology. 2000; 56: 1016-1020
- Cancer disparities by race/ethnicity and socioeconomic status.CA Cancer J Clin. 2004; 54: 78-93
- Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study.J Natl Cancer Inst. 2001; 93: 388-395
- Geographic patterns of prostate cancer mortality and variations in access to medical care in the United States.Cancer Epidemiol Biomarkers Prev. 2005; 14: 590-595
- Survival of blacks and whites after a cancer diagnosis.JAMA. 2002; 287: 2106-2113
- Cancer health disparities among Indian and Pakistani immigrants in the United States: a surveillance, epidemiology, and end results-based study from 1988 to 2003.Cancer. 2008; 113: 1423-1430
- Survival following primary androgen deprivation therapy among men with localized prostate cancer [published correction appears in JAMA. 2009;301(1):38].JAMA. 2008; 300: 173-181
- Cancer and Leukemia Group B (CALGB) 90203: a randomized phase 3 study of radical prostatectomy alone versus estramustine and docetaxel before radical prostatectomy for patients with high-risk localized disease.Urology. 2003; 62: 55-62
- Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy.J Urol. 2004; 171: 1141-1147
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