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Racial Differences in Treatment Decision-Making for Men with Clinically Localized Prostate Cancer: a Population-Based Study

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Abstract

Purpose

Racial differences in prostate cancer treatment patterns have motivated concerns about over- and undertreatment. We surveyed black and white patients with localized prostate cancer (LPC) regarding their treatment decision-making processes to gain a better perspective on factors associated with LPC treatment choice.

Methods

We conducted a population-based, cross-sectional survey of 260 men (132 black, 128 white) aged ≤75 years, with newly diagnosed LPC. Our primary outcome was treatment choice (either surgery, radiation, or watchful waiting/active surveillance (WW/AS)), and our primary predictors were race and tumor risk level.

Results

Overall, treatment choice did not differ by race. As cancer risk increased, both black and white patients were more likely to undergo surgery and less likely to receive radiation. However, the pattern of WW/AS was different between white and black men. White men were less likely to select WW/AS as cancer risk increased, while risk level was unrelated to black men undergoing WW/AS. Urologist’s recommendation had the greatest impact on men’s treatment choice, followed by tumor risk level, age, and personal preferences.

Conclusions

Although there were no overall racial differences in treatment choice, when stratified by tumor risk level, the pattern of WW/AS was different between white and black patients, suggesting that over- and undertreatment is a larger concern for black than white men. A risk-stratified approach to understand racial disparities in LPC treatment and better strategies to aid black men in their treatment decision-making are needed to reduce racial disparities in prostate cancer outcomes.

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Acknowledgments

This study was supported by a Mentored Research Scholar Grant in Applied and Clinical Research (Grant #MRSGT-06-133-01-CPPB) from American Cancer Society.

Conflict of Interest

All authors declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). The study received approval from the institutional review board at Wayne State University. A waiver of written consent was granted and an information sheet was mailed with each survey.

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Authors and Affiliations

  1. Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, 48201, USA

    Jinping Xu, James Janisse, Joel Ager & Kendra L. Schwartz

  2. Department of Oncology, Wayne State University, Detroit, MI, 48021, USA

    Julie Ruterbusch

Authors
  1. Jinping Xu
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  2. James Janisse
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  3. Julie Ruterbusch
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  4. Joel Ager
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  5. Kendra L. Schwartz
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Corresponding author

Correspondence to Jinping Xu.

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Xu, J., Janisse, J., Ruterbusch, J. et al. Racial Differences in Treatment Decision-Making for Men with Clinically Localized Prostate Cancer: a Population-Based Study. J. Racial and Ethnic Health Disparities 3, 35–45 (2016). https://doi.org/10.1007/s40615-015-0109-8

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  • DOI: https://doi.org/10.1007/s40615-015-0109-8

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