Prostate cancer management: Racial disparities in the United States.

Abstract

e16012 Background: Racial disparities in prostate cancer management have been reported. Black patients with well–differentiated disease were less likely to receive definitive therapy than whites with similar disease according to Underwood et. al., who included 142,340 patients from the Surveillance, Epidemiology and End Result (SEER) registry (J Urol, Vol. 171, 1504 – 1507, April 2004). Our objective was to identify racial disparities in the management of prostate cancer patients from the National Cancer Database. Methods: Prostate cancer treatment according to race in the USA, obtained from the National Cancer Database, was retrospectively reviewed. 1,497,540 patients with prostate cancer in 1397 US teaching and community hospitals between 2000 and 2010 were included. Chi square and Fisher tests were used for statistical analysis. Results: Black patients with stage II disease underwent radical prostatectomy significantly less than white patients (34.3% versus 43%, p<0.05). 10.9% of blacks with stage II disease did not receive any therapy, versus 6.7% of whites (p<0.05). 0.9% of whites with stage III disease didn’t receive any therapy versus 2% of blacks (p<0.05). The disparity was even more accentuated for stage IV disease, where 13.4% of blacks did not receive any form of treatment versus 10.3% of whites (p<0.05). 44% of blacks with localized disease (stage I and II) received radiation therapy, 34% received surgery. Blacks were less likely to receive radical prostatectomy for stage I and II disease compared to whites (34% versus 43%, p<0.05). Stage IV disease at presentation was more common in blacks (7.2%) than in whites (4.7%, p<0.05). Conclusions: This is the largest study which has analyzed ethnicity and prostate cancer management. Significant racial disparities exist in prostate cancer management between whites and blacks in the USA. Our study reveals that blacks are more likely to receive radiation therapy and less likely to get radical prostatectomy for stage I and II disease. A higher percentage of black patients with stage II, III or IV disease do not undergo any treatment as compared to whites. Blacks are also more likely to present with stage IV disease.