Abstract
Introduction. Prostate cancer is the most common cancer among men in USA. The surgical outcomes of prostate cancer remain inconsistent. Barriers such as socioeconomic factors may play a role in patients' decision of refusing recommended cancer-directed surgery. Methods. The Nebraska Cancer Registry data was used to calculate the proportion of prostate cancer patients recommended the cancer-directed surgery and the surgery refusal rate. Multivariate logistic regression was applied to analyze the socioeconomic indicators that were related to the refusal of surgery. Results. From 1995 to 2012, 14,876 prostate cancer patients were recommended to undergo the cancer-directed surgery in Nebraska, and 576 of them refused the surgery. The overall refusal rate of surgery was 3.9% over the 18 years. Patients with early-stage prostate cancer were more likely to refuse the surgery. Patients who were Black, single, or covered by Medicaid/Medicare had increased odds of refusing the surgery. Conclusion. Socioeconomic factors were related to the refusal of recommended surgical treatment for prostate cancer. Such barriers should be addressed to improve the utilization of surgical treatment and patients' well-being.
Highlights
Prostate cancer is the most common cancer among men in USA
In a literature review of localized cases, in which the 10-year cancer-specific survival was compared for radical prostatectomy, radiation therapy, and deferred treatment, it turned out that the surgical approach had the best survival rate [4]
The Prostate Intervention Versus Observation Trial (PIVOT), which directly compared radical prostatectomy with watchful waiting, suggested that the 10-year survival rates were not significantly different for prostatectomy and watchful waiting, and there was no significant difference in prostate cancer-specific mortality for these two approaches as well (HR, 0.63; 95% CI, 0.36–1.09; p = 0.09) [5]
Summary
The surgical outcomes of prostate cancer remain inconsistent Barriers such as socioeconomic factors may play a role in patients’ decision of refusing recommended cancer-directed surgery. Prostate cancer is most frequently found among men over 50 years old, it is often caught at early stages by screening, and these early-stage cases are expected to live relatively long if treated correctly. This makes patients with localized and regional prostate cancer have a five-year survival rate of almost 100%, but it drops dramatically to 26% among patients with distant stage prostate cancer [2]. For late-stage patients, study showed surgery can only serve as a palliate care, and no significant benefit for overall survival was observed after the surgery [6]
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