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    Prostate Ca study reveals more evidence of racial disparity


    The study, which was published online ahead of print in European Urology (Aug. 1, 2017), analyzed data from the National Cancer Data Base for men age ≥40 years receiving care for biopsy-confirmed localized intermediate/high-risk prostate cancer (Gleason Score ≥7) diagnosed between January 2004 and December 2013. It included 223,873 Caucasian men and 59,262 African-American men seen at 356 facilities and found that definitive therapy (radical prostatectomy, brachytherapy, or external beam radiotherapy) was received within 180 days of diagnosis by 83% of Caucasian men and 74% of African-American men.

    After adjusting for sociodemographic and clinical factors, multilevel logistic regression revealed that 39% of facilities favored definitive therapy in Caucasians compared with African-Americans. Only 1% of facilities demonstrated a statistically significant rate favoring definitive therapy among African-Americans compared with Caucasians.

    Analyses of the data by year showed the rate of definitive therapy increased slightly over the study period—from 81% to 83% among Caucasians and from 73% to 75% among African-Americans. The rate of increase was similar in the two groups.

    Read: Prostate MRI has value, but results are not ‘gospel’

    Multivariable subgroup analyses showed that the effect of race on receipt of definitive therapy varied with geographic region (U.S. census division) and facility type (community cancer program, comprehensive community cancer program, academic/research, integrated network cancer program), but not facility volume. The odds ratio favoring receipt of definitive therapy by Caucasian men was highest in the South Atlantic census division and significantly higher in seven of the eight other divisions, with the exception being the Mountain division. In the analysis of facility type, the odds ratio favoring receipt of definitive therapy by Caucasian men was highest at academic/research institutions, but the difference was also statistically significant at the other facility types.

    The National Cancer Data Base is a nationwide database of information on patterns of cancer care outcomes from more than 1,500 Commission on Cancer-accredited programs in the United States and Puerto Rico, and it captures about 70% of newly diagnosed malignancies. Only facilities that treated at least 50 Caucasian and 50 African-American men throughout the study period were included in the study.

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