The management of adenocarcinoma of the prostate in rural Georgia: A population-based analysis.

Abstract

273 Background: The management of adenocarcinoma of the prostate (ACP) in minority populations and in the rural setting remains understudied. We conducted a population-based analysis exploring the management of ACP in rural Georgia. Methods: All cases of ACP diagnosed from 2001 to 2003 in a rural, 33-county, Southwest Georgia region were included. Data were obtained for all patients through direct medical record abstraction. Patient characteristics were described and associated with three specific outcomes: receipt of therapy, initiation of planned therapy, and completion of radiation therapy (RT) when initiated. Results: One thousand eighty seven patients were available for the analysis; median patient age was 69, and 44% of the patients were African American (AA). A total of 804 patients underwent a course of definitive therapy or elected to pursue regular active surveillance (AS). Of the patients 8.9% underwent radical prostatectomy (RP) alone, 3.1% RP and external beam radiation therapy (EBRT), 30.2 % EBRT alone, 10.8% brachytherapy (BT) alone, and 44.5% combination EBRT and BT; 2.5 % of patients underwent AS. Hormone therapy (HT) was used in 43.8% of all patients available for analysis. In a multivariable analysis conducted for the entire patient cohort, not being married (OR 0.60, 95% CI 0.42-0.85, p=0.004), lack of insurance (OR 0.32, 95% CI 0.16-0.61, p=0.008), and older age (OR 0.93, 95% CI 0.91-0.95, p<0.001) were all independently associated with not receiving definitive therapy. Race was not significantly related to receipt of definitive therapy. The full course of EBRT was successfully completed as planned in 98.4% of patients. Conclusions: Amongst those patients undergoing therapy for ACP in rural Georgia, a combination of BT and EBRT was the most common treatment modality. In contrast to recent studies, we found that race was not a significant predictor of receipt of care in Southwest Georgia. In this rural setting, EBRT was associated with extremely high rates of treatment completion. Despite the geographic and socioeconomic challenges associated with rural residency, our population-based study demonstrates that EBRT is a common treatment modality, with high patient compliance, even when used in a rural setting.