Men of Higher Socioeconomic Status Have Improved Outcomes After Radical Prostatectomy for Localized Prostate Cancer

Abstract

We sought to evaluate the impact of socioeconomic status (SES) on the likelihood of undergoing radical prostatectomy (RP) or external beam radiation therapy (XRT) and the ensuing effect on cancer-specific survival (CSS) after treatment for men with low-risk prostate cancer. Using the California Cancer Registry database, we identified 123,953 men diagnosed with localized, Gleason ≤7 prostate cancer from 1996 to 2005. Patients were separated into quintiles based on socioeconomic status and were stratified by race, age, year of diagnosis, and treatment. Logistic regression and Kaplan-Meier analyses were used to determine the likelihood of undergoing RP or XRT and cancer-specific survival. In the final cohort, 39,234 patients (31.7%) and 42,431 patients (34.3%) underwent RP and XRT as initial therapy. Men of lower SES were less likely to undergo RP or XRT. Men undergoing RP in the lowest SES were twice as likely to die of prostate cancer (HR 1.99, 95% CI 1.28-3.09, P = .002) than men in the highest SES. This difference was even more profound when adjusted for race (HR 2.20, 95% CI 1.38-3.50, P = .001). Similarly, men in the lowest SES who underwent XRT were also approximately twice as likely to die of prostate cancer (HR 2.24, 95% CI 1.71-2.94, P <.001) than men of the highest SES, regardless of race. Men of lower SES are less likely to undergo RP or XRT for the management of localized prostate cancer. After RP or XRT, men of lower SES have a decreased cancer-specific survival compared with men of higher SES.