Impact of socioeconomic status and race on clinical parameters of patients undergoing radical prostatectomy in an equal access health care system

Abstract

Objectives. To analyze the relationships among socioeconomic status (SES), race, and the clinical parameters of patients undergoing radical prostatectomy (RP) in an equal access health care system. Methods. The Department of Defense Center for Prostate Disease Research longitudinal prostate cancer database from multiple military institutions was used to analyze the clinical, pathologic, and outcome data of 1058 patients with localized (Stage T2c or lower) prostate cancer and a preoperative prostate-specific antigen (PSA) level of 20 ng/mL or less who underwent RP between January 1987 and December 1997. Military rank (officer versus enlisted) was used as a surrogate measure of SES. Results. The percentage of patients with pathologic Gleason grade 7 or greater prostate cancer was higher in enlisted (45%) than in officer (37%) patients ( P = 0.021). However, no difference was found between these groups with respect to pathologic stage or biochemical recurrence rates. African Americans presented at a younger age ( P = 0.003), with a higher pretreatment PSA level ( P = 0.001), and demonstrated higher biochemical recurrence rates than other ethnic groups ( P = 0.037). The Cox proportional hazards analysis showed that a lower SES ( P = 0.010) but not African American race ( P = 0.696) was an independent predictor of a higher grade (Gleason grade 7 or higher) cancer. However, biochemical progression was more common in African American men ( P = 0.035) and was not related to SES ( P = 0.883). Conclusions. In an equal access health care system, patients of lower SES presented with higher grade prostate cancer at the time of RP. However, only African American race predicted biochemical progression after RP.