Racial Differences in Prostate Cancer Treatment Outcomes

Nikki Peters, BA; Katrina Armstrong, MD


Cancer Nurs. 2005;28(2):108-118. 

In This Article

Abstract and Introduction

Although differences in prostate cancer incidence and mortality between black and white men are widely accepted, the existence of racial differences in treatment outcomes remains controversial. We conducted a systematic review of racial differences in prostate cancer treatment outcomes. Systematic review of literature from 1992-2002 was conducted. Database searches were performed using the terms: prostate cancer (keyword) or prostate neoplasm (subject heading) + blacks (subject heading) or blacks (keyword) + African-Americans (subject heading or African-Americans (keyword). Two hundred fifty-eight relevant articles were identified; 29 fit the inclusion criteria. All but 3 were retrospective. Seven (24%) studies were conducted at Veterans Affairs medical centers. Treatment included radical prostatectomy (15 studies), hormonal therapy (5 studies), and radiotherapy (12 studies). Three studies included more than 1 treatment. Twenty-three (79%) studies, observed no significant difference in treatment outcomes between races. The remainder found worse outcomes among black men, including worse 5-year survival (HR range, 2.35-96.74) and higher rates of PSA failure (OR range, 1.15-1.69). Most studies investigating racial differences in prostate cancer treatment outcomes over the past 10 years found no difference between races after controlling for tumor and patient characteristics. Efforts to narrow the gap between black and white prostate cancer mortality should focus on ensuring that all patients receive optimal treatment and that all patients become informed about the use of screening for early cancer detection. Research should focus on interventions to reduce advanced presentation of the disease and disease-related mortality among black men.

Prostate cancer is the most common nondermatological cancer among men in the United States, and the second most common cause of cancer death. In 2002, a total of 189,000 men were diagnosed with prostate cancer and 30,200 died from the disease.[1] Black men are 2½ times more likely to die of prostate cancer than white men.[2] From 1995 to 1999, US age-adjusted death rates for prostate cancer were 72.8 per 100,000 for black men and 31.2 per 100,000 for white men.[3]

The causes of the increased prostate cancer mortality among black men are poorly understood. Prostate cancer incidence is higher in black men. Surveillance, Epidemiology, and End Results (SEER) 1995-1999 incidence rates were 266.8 for black men and 163.2 for white men, per 100,000 population.[3] This difference in incidence has been attributed to factors such as diet, genetic variability, and socioeconomic status.[4,5,6,7] Black men are more likely to be diagnosed with an advanced-stage disease and with higher PSA levels than white men.[8,9] Among patients diagnosed with localized prostate cancer, black men have been consistently found to be less likely to undergo radical prostatectomy and more likely to be managed by watchful waiting.[10,11] Although many experts believe this difference in treatment contributes to the difference in survival, this link remains controversial because of the lack of definitive data about the effect of radical prostatectomy on prostate cancer.[12,13]

In addition to differences in incidence, extent of disease at presentation and type of treatment, racial differences in outcomes after treatment may contribute to differences in mortality. In order to gain a better understanding of this issue, we conducted a review of literature on prostate cancer treatment outcomes among black and white men over the past 10 years.


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