Racial and geographic differences in diagnosis and treatment of prostate cancer in Louisiana
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Description
Objectives. To compare stage at diagnosis and stage-specific treatment of prostate cancer by race and by urban/rural residence in Louisiana Methods. In 1997, a total of 2,953 prostate cancer cases were diagnosed in Louisiana. Of these, the study cohort included all eligible African Americans (N = 841) and a random sample of eligible whites (N = 811). Data came from the Louisiana Tumor Registry and the 'Pattern of Patient Care for Prostate Cancer in Louisiana' special study. The tumor registry documents patients' demographics, report source, tumor stage at diagnosis and first course of treatment. The special study verified treatment information, collected additional therapeutic information from urologist offices, and recorded Gleason score, prediagnostic PSA value, comorbidity, and type of insurance. Stage at diagnosis and stage-specific treatment patterns were outcomes in this analysis Results. African-American men were about twice as likely as whites to be diagnosed with advanced stages of prostate cancer (OR = 1.96, 95% CI 1.49--2.58). Adjustment for age at diagnosis, comorbidity, insurance, place of residence, and family history of cancer did not change the odds ratio. Rural residents, particularly African-Americans, were more likely than urban men to present with Stage IV (20.3% versus 8.2%) or unknown stage (6.2% versus 3.7%) disease A marked racial difference was observed in receiving aggressive therapy for early stages of prostate cancer. Approximately three quarters of white patients and half of the African Americans with Stage I disease received either radical prostatectomy or radiation therapy. Comparable findings were also noted for Stage II diagnoses (76.3% and 63.7% respectively). While PSA, age, comorbidity, place of residence, and insurance were significantly associated with aggressive treatments, African-American men remained significantly less likely to be treated aggressively than whites for same stage of prostate cancer (Stage I, OR = 2.38 95% CI 1.57--3.60; Stage II, OR = 2.27, 95% CI 1.45--3.55) after adjustment for these factors The racial difference in treatments was not significantly different for Stages III and IV. Rural men, especially African Americans, were less likely to undergo radical prostatectomy or radiation therapy for Stage I and II disease Conclusion. African-American men and rural residents in Louisiana are at increased risk for diagnosis with advanced stages of prostate cancer and are less likely to receive stage-specific aggressive cancer treatment for early stage disease than their white or urban counterparts