1
|
Vickers AJ, Elfiky A, Freeman VL, Roach M. Race, Biology, Disparities, and Prostate Cancer. Eur Urol 2022; 81:463-465. [PMID: 35216858 DOI: 10.1016/j.eururo.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Vincent L Freeman
- Division of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, IL, USA
| | - Mack Roach
- Department of Radiation Oncology and Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| |
Collapse
|
2
|
Cackowski FC, Mahal B, Heath EI, Carthon B. Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal? Am Soc Clin Oncol Educ Book 2021; 41:1-12. [PMID: 33979195 DOI: 10.1200/edbk_321195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite notable screening, diagnostic, and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. Although commonly discussed in the context of men of African descent, disparities also exist based on socioeconomic level, education level, and geographic location. The factors in these disparities span systemic access issues affecting availability of care, provider awareness, and personal patient views and mistrust. In this review, we will discuss common themes that patients have noted as impediments to care. We will review how equitable access to care has helped improve outcomes among many different groups of patients, including those with local disease and those with metastatic castration-resistant prostate cancer. Even with more advanced presentation, challenges with recommended screening, and lower rates of genomic testing and trial inclusion, Black populations have benefited greatly from various modalities of therapy, achieving comparable and at times superior outcomes with certain types of immunotherapy, chemotherapy, androgen receptor-based inhibitors, and radiopharmaceuticals in advanced disease. We will also briefly discuss access to genomic testing and differences in patterns of gene expression among Black patients and other groups that are traditionally underrepresented in trials and genomic cohort studies. We propose several strategies on behalf of providers and institutions to help promote more equitable care access environments and continued decreases in prostate cancer disparities across many subgroups.
Collapse
Affiliation(s)
| | - Brandon Mahal
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | | |
Collapse
|
3
|
Carthon B, Sibold HC, Blee S, D Pentz R. Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment. Oncologist 2021; 26:537-548. [PMID: 33683758 DOI: 10.1002/onco.13749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exist among Black men in this country. The primary objective of this systematic review is to describe the reported disparities in screening, diagnostics, and treatments as well as efforts to alleviate these disparities through community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, subanalyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal-access care environments have shown similar outcomes regardless of race. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials, and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. IMPLICATIONS FOR PRACTICE: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher prostate-specific antigen, and other adverse factors, but outcomes can be attenuated in trials or in equal-access care environments. Recent data have shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts, and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities.
Collapse
Affiliation(s)
- Bradley Carthon
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Hannah C Sibold
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Shannon Blee
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rebecca D Pentz
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine prostate cancer racial disparities specific to the African-American population. RECENT FINDINGS African-American men are more likely to be diagnosed with prostate cancer, present at an earlier age; are more likely to have locally advanced or metastatic disease at diagnosis; and have suboptimal outcomes to standard treatments. Prostate cancer treatment requires a nuanced approach, particularly when applying screening, counseling, and management of African-American men. Oncological as well as functional outcomes may differ and are potentially due to a combination of genetic, molecular, behavioral, and socioeconomic factors.
Collapse
Affiliation(s)
- Zachary L Smith
- Department of Surgery, Section of Urology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6038, Chicago, IL, 60637, USA.
| | - Scott E Eggener
- Department of Surgery, Section of Urology, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 6038, Chicago, IL, 60637, USA
| | - Adam B Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Tarry Building Room 16-703, 300 E. Superior Street, Chicago, IL, 60611, USA
| |
Collapse
|
5
|
Abstract
Men of African origin are disproportionately affected by prostate cancer: prostate cancer incidence is highest among men of African origin in the USA, prostate cancer mortality is highest among men of African origin in the Caribbean, and tumour stage and grade at diagnosis are highest among men in sub-Saharan Africa. Socioeconomic, educational, cultural, and genetic factors, as well as variations in care delivery and treatment selection, contribute to this cancer disparity. Emerging data on single-nucleotide-polymorphism patterns, epigenetic changes, and variations in fusion-gene products among men of African origin add to the understanding of genetic differences underlying this disease. On the diagnosis of prostate cancer, when all treatment options are available, men of African origin are more likely to choose radiation therapy or to receive no definitive treatment than white men. Among men of African origin undergoing surgery, increased rates of biochemical recurrence have been identified. Understanding differences in the cancer-survivorship experience and quality-of-life outcomes among men of African origin are critical to appropriately counsel patients and improve cultural sensitivity. Efforts to curtail prostate cancer screening will likely affect men of African origin disproportionately and widen the racial disparity of disease.
Collapse
|
6
|
Pierre-Louis BJ, Moore AD, Hamilton JB. The Military Health Care System May Have the Potential to Prevent Health Care Disparities. J Racial Ethn Health Disparities 2014; 2:280-9. [DOI: 10.1007/s40615-014-0067-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/11/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
|
7
|
Gaines AR, Turner EL, Moorman PG, Freedland SJ, Keto CJ, McPhail ME, Grant DJ, Vidal AC, Hoyo C. The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort. Cancer Causes Control 2014; 25:1029-35. [PMID: 24879044 DOI: 10.1007/s10552-014-0402-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 05/16/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Population-based studies have established a link between race and prostate cancer (PC) risk, but whether race predicts PC after adjusting for clinical characteristics is unclear. We investigated the association between race and risk of low- and high-grade PC in men undergoing initial prostate biopsy in an equal access medical center. METHODS We conducted a retrospective record review of 887 men (48.6 % black, 51.4 % white) from the Durham Veterans Affairs Medical Center who underwent initial prostate biopsy between 2001 and 2009. Multivariable logistic regression analysis of race and biopsy outcome was conducted adjusting for age, body mass index, number of cores taken, prostate-specific antigen (PSA), and digital rectal examination findings. Multinomial logistic regression was used to test the association between black race and PC grade (Gleason <7 vs. ≥7). RESULTS Black men were younger at biopsy (61 vs. 65 years, p < 0.001) and had a higher pre-biopsy PSA (6.6 vs. 5.8 ng/ml, p = 0.001). A total of 499 men had PC on biopsy (245 low grade; 254 high grade). In multivariable analyses, black race was significantly predictive of PC overall [odds ratio 1.50, p = 0.006] and high-grade PC [relative risk ratio (RRR) 1.84, p = 0.001], but was not significantly associated with low-grade PC (RRR 1.29, p = 0.139). CONCLUSION In an equal access healthcare facility, black race was associated with greater risk of PC detection on initial biopsy and of high-grade PC after adjusting for clinical characteristics. Additional investigation of mechanisms linking black race and PC risk and PC aggressiveness is needed.
Collapse
|
8
|
Agoua N, Vian E, Dumoulin M, Blanchet P. Résultats de la radiothérapie de rattrapage pour récidive biologique après prostatectomie radicale dans la population africaine-caribéene de la Guadeloupe. Prog Urol 2013; 23:128-36. [DOI: 10.1016/j.purol.2012.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 08/09/2012] [Accepted: 09/09/2012] [Indexed: 10/27/2022]
|
9
|
Differences in disease presentation, treatment outcomes, and toxicities in African American patients treated with radiation therapy for prostate cancer. Am J Clin Oncol 2013; 35:566-71. [PMID: 21694572 DOI: 10.1097/coc.0b013e3182208262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We analyzed differences in disease presentation, outcomes, and toxicities between African American (AA) and White (W) men treated with definitive radiation therapy for their prostate cancer. METHODS Three thousand one hundred eighty cases of prostate cancer treated with various radiation modalities at a single institution were reviewed. The cohort consisted of 92% W patients and 8% AA patients. Clinical and pathologic characteristics at presentation, treatment outcomes, and related toxicities were analyzed between the 2 groups. The median follow-up was 6.6 years (0.6 to 22.4 y). RESULTS At presentation, AA men were younger (P<0.001) and more likely to have a Gleason score of ≥7 (47.9% vs. 39.2%, P=0.006). No difference in the 5 or 10-year rates of biochemical failure, disease-free survival, or distant metastases were noted. Although there was a trend for improved 10-year overall survival for AA men (65.3% vs. 57.4%, P=0.06), cause-specific survival was significantly improved at 10 years (98.6% vs. 90.6%, P=0.002). Similar findings were seen when controlling for radiation therapy dose, the use of hormonal therapy, and modality of radiation therapy used. Overall, genitourinary/gastrointestinal toxicities were similar regardless of the modality used. CONCLUSIONS Despite differences in presenting characteristics, AA men did not have inferior clinical outcomes but rather improved cause-specific survival when treated with standard of care radiation therapy. Regardless of the treatment modality used, toxicities between AA and W men were comparable.
Collapse
|
10
|
Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the Duke Prostate Center. Prostate Cancer Prostatic Dis 2012; 16:85-90. [PMID: 23069729 DOI: 10.1038/pcan.2012.38] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Active surveillance (AS) is increasingly utilized in low-risk prostate cancer (PC) patients. Although black race has traditionally been associated with adverse PC characteristics, its prognostic value for patients managed with AS is unclear. METHODS A retrospective review identified 145 patients managed with AS at the Duke Prostate Center from January 2005 to September 2011. Race was patient-reported and categorized as black, white or other. Inclusion criteria included PSA <10 ng ml(-1), Gleason sum ≤ 6, and ≤ 33% of cores with cancer on diagnostic biopsy. The primary outcome was discontinuation of AS for treatment due to PC progression. In men who proceeded to treatment after AS, the trigger for treatment, follow-up PSA and biopsy characteristics were analyzed. Time to treatment was analyzed with univariable and multivariable Cox proportional hazards models and also stratified by race. RESULTS In our AS cohort, 105 (72%) were white, 32 (22%) black and 8 (6%) another race. Median follow-up was 23.0 months, during which 23% percent of men proceeded to treatment. The demographic, clinical and follow-up characteristics did not differ by race. There was a trend toward more uninsured black men (15.6% black, 3.8% white, 0% other, P = 0.06). Black race was associated with treatment (hazard ratio (HR) 2.93, P = 0.01) as compared with white. When the analysis was adjusted for socioeconomic and clinical parameters at the time of PC diagnosis, black race remained the sole predictor of treatment (HR 3.08, P = 0.01). Among men undergoing treatment, the trigger was less often patient driven in black men (8 black, 33 white, 67% other, P = 0.05). CONCLUSIONS Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.
Collapse
|
11
|
Dilling TJ, Bae K, Paulus R, Watkins-Bruner D, Garden AS, Forastiere A, Kian Ang K, Movsas B. Impact of gender, partner status, and race on locoregional failure and overall survival in head and neck cancer patients in three radiation therapy oncology group trials. Int J Radiat Oncol Biol Phys 2011; 81:e101-9. [PMID: 21549515 PMCID: PMC3170693 DOI: 10.1016/j.ijrobp.2011.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/16/2010] [Accepted: 01/10/2011] [Indexed: 12/31/2022]
Abstract
PURPOSE We investigated the impact of race, in conjunction with gender and partner status, on locoregional control (LRC) and overall survival (OS) in three head and neck trials conducted by the Radiation Therapy Oncology Group (RTOG). METHODS AND MATERIALS Patients from RTOG studies 9003, 9111, and 9703 were included. Patients were stratified by treatment arms. Covariates of interest were partner status (partnered vs. non-partnered), race (white vs. non-white), and sex (female vs. male). Chi-square testing demonstrated homogeneity across treatment arms. Hazards ratio (HR) was used to estimate time to event outcome. Unadjusted and adjusted HRs were calculated for all covariates with associated 95% confidence intervals (CIs) and p values. RESULTS A total of 1,736 patients were analyzed. Unpartnered males had inferior OS rates compared to partnered females (adjusted HR = 1.22, 95% CI, 1.09-1.36), partnered males (adjusted HR = 1.20, 95% CI, 1.09-1.28), and unpartnered females (adjusted HR = 1.20, 95% CI, 1.09-1.32). White females had superior OS compared with white males, non-white females, and non-white males. Non-white males had inferior OS compared to white males. Partnered whites had improved OS relative to partnered non-white, unpartnered white, and unpartnered non-white patients. Unpartnered males had inferior LRC compared to partnered males (adjusted HR = 1.26, 95% CI, 1.09-1.46) and unpartnered females (adjusted HR = 1.30, 95% CI, 1.05-1.62). White females had LRC superior to non-white males and females. White males had improved LRC compared to non-white males. Partnered whites had improved LRC compared to partnered and unpartnered non-white patients. Unpartnered whites had improved LRC compared to unpartnered non-whites. CONCLUSIONS Race, gender, and partner status had impacts on both OS and locoregional failure, both singly and in combination.
Collapse
Affiliation(s)
- Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Levy A, Chargari C, Desrez G, Leroux S, Sneyd MJ, Mozer P, Comperat E, Feuvret L, Lang P, Lopez S, Assouline A, Hemery C, Mazeron JJ, Simon JM. Poorer outcome in Polynesian patients with prostate cancer treated with definitive conformational radiation therapy. Radiother Oncol 2011; 101:502-7. [PMID: 21723636 DOI: 10.1016/j.radonc.2011.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/19/2011] [Accepted: 05/26/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare freedom from biochemical failure (FFBF) of French Polynesian (FP) and Native European (NE) prostate cancer patients after definitive conformal radiotherapy (RT). PATIENTS AND METHODS Data were reviewed from medical records of 152 consecutive patients (46 FP and 106 NE) with clinically localised prostate cancer treated with definitive RT. Neoadjuvant androgen deprivation therapy (ADT) was used in 22% of cases. Definition for biochemical failure was a rise by 2 ng/mL or more above the nadir prostate-specific antigen (PSA) level. The median follow-up was 34 months. RESULTS In comparison to NE patients, FP patients were younger (p=0.002) with a higher low-risk proportion (p=0.06). Probability of 5-year FFBF was 77% in the NE cohort and 58.0% in the FP cohort (p=0.017). Univariate analysis showed that FP ethnicity was associated with worse prognosis in high-risk tumours (p=0.004). Cox multivariate analysis showed that factors associated with FFBF were risk category (p<0.017), and FP origin (p=0.03), independently of ADT and radiation dose. CONCLUSION FP ethnicity was an independent prognostic factor for biochemical relapse after definitive conformal RT for prostate cancer.
Collapse
Affiliation(s)
- Antonin Levy
- Department of Radiation Oncology, Pitie-Salpetriere University Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Raymundo EM, Rice KR, Chen Y, Zhao J, Brassell SA. Prostate cancer in Asian Americans: incidence, management and outcomes in an equal access healthcare system. BJU Int 2010; 107:1216-22. [DOI: 10.1111/j.1464-410x.2010.09685.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
Sridhar G, Masho SW, Adera T, Ramakrishnan V, Roberts JD. Do African American Men Have Lower Survival From Prostate Cancer Compared With White Men? A Meta-analysis. Am J Mens Health 2010; 4:189-206. [DOI: 10.1177/1557988309353934] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer is the second leading cause of cancer-related mortality in men. This meta-analysis was conducted to investigate the relationship between race and survival from prostate cancer. A systematic review of articles published from 1968 to 2007 assessing survival from prostate cancer was conducted. Analysis of unadjusted studies reported that African American men have an increased risk of all-cause mortality (hazard ratio [HR] = 1.47, 95% confidence interval [CI] = 1.31-1.65, p < .001). However, examination of adjusted studies identified no difference (HR = 1.07, 95% CI = 0.94-1.22, p = .308). No statistically significant difference was observed in prostate cancer—specific survival in both analyses using unadjusted (HR = 1.11, 95% CI = 0.94-1.31, p = .209) and adjusted studies (HR = 1.15, 95% CI = 0.95-1.41, p = .157). This meta-analysis concludes that there are no racial differences in the overall and prostate cancer—specific survival between African American and White men.
Collapse
|
15
|
Sears CLG, Wright J, O'Brien J, Jezior JR, Hernandez SL, Albright TS, Siddique S, Fischer JR. The Racial Distribution of Female Pelvic Floor Disorders in an Equal Access Health Care System. J Urol 2009; 181:187-92. [DOI: 10.1016/j.juro.2008.09.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Christine L. Gray Sears
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
- Department of Urology, Walter Reed Army Medical Center, Washington, D. C
| | - Johnnie Wright
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | - Jennie O'Brien
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | - James R. Jezior
- Department of Urology, Walter Reed Army Medical Center, Washington, D. C
| | - Sandra L. Hernandez
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | | | - Sohail Siddique
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| | - John R. Fischer
- National Institutes of Health/National Capital Consortium Fellowship Program, Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D. C
| |
Collapse
|
16
|
Spencer BA, Miller DC, Litwin MS, Ritchey JD, Stewart AK, Dunn RL, Gay EG, Sandler HM, Wei JT. Variations in Quality of Care for Men With Early-Stage Prostate Cancer. J Clin Oncol 2008; 26:3735-42. [DOI: 10.1200/jco.2007.13.2555] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The commencement of quality-improvement initiatives such as Pay for Performance and the Physician Consortium for Performance Improvement has underscored calls to evaluate the quality of cancer care on a patient level for nationally representative samples. Methods We sampled early-stage prostate cancer cases diagnosed in 2000 through 2001 from the American College of Surgeons National Cancer Data Base and explicitly reviewed medical records from 2,775 men (weighted total = 55,160 cases) treated with radical prostatectomy or external-beam radiation therapy. We determined compliance with 29 quality-of-care disease-specific structure and process indicators developed by RAND, stratified by race, geographic region, and hospital type. Results Overall compliance exceeded 70% for structural and pretherapy disease assessment indicators but was lower for documentation of pretreatment functioning (46.4% to 78.4%), surgical pathology (37.1% to 86.3%), radiation technique (62.6% to 88.3%), and follow-up (55%). Geographic variations were observed as higher compliance in the South Atlantic division than the New England division for having at least one board-certified urologist (odds ratio [OR], 9.2; 95% CI, 1.9 to 45.0), at least one board-certified radiation oncologist (OR, 3.3; 95% CI, 1.2 to 9.0), use of Gleason grading (OR, 4.1; 95% CI, 1.2 to 13.8), and administering total radiation dose ≥ 70 Gy (OR, 3.1; 95% CI, 1.6 to 6.1). Teaching/research hospitals and Comprehensive Cancer Centers had higher compliance than Community Cancer Centers, whereas racial differences were not observed for any indicator. Conclusion The significant and unwarranted variations observed for these quality indicators by census division and hospital type illustrate the inconsistencies in prostate cancer care and represent potential targets for quality improvement. The lack of racial disparities suggests equity in care once a patient initiates treatment.
Collapse
Affiliation(s)
- Benjamin A. Spencer
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - David C. Miller
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Mark S. Litwin
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jamie D. Ritchey
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Andrew K. Stewart
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Rodney L. Dunn
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - E. Greer Gay
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Howard M. Sandler
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - John T. Wei
- From the Departments of Urology and Epidemiology, College of Physicians and Surgeons, Columbia University, New York, NY; Departments of Urology and Radiation Oncology, University of Michigan, Ann Arbor, MI; Departments of Urology and Health Services, David Geffen School of Medicine, School of Public Health, and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| |
Collapse
|
17
|
Byers TE, Wolf HJ, Bauer KR, Bolick-Aldrich S, Chen VW, Finch JL, Fulton JP, Schymura MJ, Shen T, Van Heest S, Yin X. The impact of socioeconomic status on survival after cancer in the United States. Cancer 2008; 113:582-91. [DOI: 10.1002/cncr.23567] [Citation(s) in RCA: 312] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
18
|
Affiliation(s)
- Otis W Brawley
- Department of Hematology and Oncology, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | | |
Collapse
|
19
|
Konski AA, Pajak TF, Movsas B, Coyne J, Harris J, Gwede C, Garden A, Spencer S, Jones C, Watkins-Bruner D. Disadvantage of Men Living Alone Participating in Radiation Therapy Oncology Group Head and Neck Trials. J Clin Oncol 2006; 24:4177-83. [PMID: 16943534 DOI: 10.1200/jco.2006.06.2901] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study evaluated whether males without partners were disadvantaged for survival in Radiation Therapy Oncology Group (RTOG) head and neck cancer clinical trials. Methods Patients treated on three RTOG trials were studied. The Cox proportional hazards model was used to determine if sex and the interaction between sex and marital/partner status were independent prognostic variables for overall survival controlling for Karnofsky performance status, tumor stage, nodal stage, primary site, and protocol treatment. Results A total of 1,901 patients (1,509 men) were entered onto the three RTOG trials, with 1,822 (1,438 men) analyzable patients. Prognostic variables independent of disease-related variables for survival in multivariate analyses restricted to men were age, marital/partner status, and income. Conclusion The apparent disadvantage of unpartnered men is striking, even after controlling for disease and other demographic variables. Possible explanations could easily be tested in observational studies, leading to evaluation of simple interventions to improve their outcome.
Collapse
Affiliation(s)
- Andre A Konski
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize single-institution prostate-cancer-outcomes databases (which are most commonly derived from large academic medical centers, Veterans Affairs medical centers, and military hospitals) to summarize the design and development of three well characterized outcomes databases that combine data from multiple sites (Carcinoma of the Prostate Strategic Urological Research Endeavor, Center for Prostate Disease Research, and the Shared Equal Access Regional Cancer Hospital database) and to use the examples of obesity and prostate-specific antigen changes over time to highlight the importance of these databases in prostate-cancer outcomes. RECENT FINDINGS Multiple databases have demonstrated that obese men are at greater risk of biochemical progression following radical prostatectomy. In addition, objective data have shown that it is more difficult to operate on obese men leading to greater risk of positive surgical margins, which may contribute to poorer outcomes. Several databases have shown that a rapidly increasing prostate-specific antigen, measured either before diagnosis or after failed primary therapy, is associated with increased risk of prostate-cancer-specific mortality. SUMMARY Outcomes databases are extremely useful tools. They have lead to dramatic improvements of our understanding of prostate cancer. The challenge is to use this information from past patients to help us better manage our current and future patients.
Collapse
Affiliation(s)
- Stephen J Freedland
- Department of Surgery, Division of Urology, Duke University School of Medicine, Durham, NC 27710, USA.
| | | | | |
Collapse
|
21
|
Freedland SJ, Isaacs WB. Explaining racial differences in prostate cancer in the United States: sociology or biology? Prostate 2005; 62:243-52. [PMID: 15389726 DOI: 10.1002/pros.20052] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Black men in the United States have the highest incidence and mortality from prostate cancer in the world. Even after adjusting for stage at diagnosis, black men have higher mortality rates than white men. Multiple reasons have been postulated to explain these findings including access to care, attitudes about care, socioeconomic and education differences, differences in type and aggressiveness of treatment, dietary, and genetic differences. While each reason may contribute to the higher incidence or higher mortality, likely combinations of reasons will best explain all the findings. Racial differences in socioeconomic status have been well established and we review the significance of these findings in relationship to prostate cancer. Also, with recent advances in the understanding of genetic variation in the human genome, in general, and in the genes involved in pathways relevant to prostate cancer biology, in particular, a number of genes with alleles which differ in frequency between black and white men have been proposed as a genetic cause or contributor to the increased prostate cancer risk in black men. However, the clinical significance of these genetic differences is not fully known. Finally, we conclude with some thoughts as to how to integrate the findings from sociological as well as biological studies and touch upon methods to reduce the disparate burden of prostate cancer among blacks in the United States.
Collapse
Affiliation(s)
- Stephen J Freedland
- The Brady Urological Institute, Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287-2101, USA.
| | | |
Collapse
|
22
|
Johnson TK, Gilliland FD, Hoffman RM, Deapen D, Penson DF, Stanford JL, Albertsen PC, Hamilton AS. Racial/Ethnic differences in functional outcomes in the 5 years after diagnosis of localized prostate cancer. J Clin Oncol 2004; 22:4193-201. [PMID: 15483030 DOI: 10.1200/jco.2004.09.127] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We investigated racial/ethnic differences in functional outcomes up to 5 years after diagnosis among men with aggressively treated localized prostate cancer. PATIENTS AND METHODS Patients were from the Prostate Cancer Outcomes Study, a population-based cohort study that surveyed patients at 6, 12, 24, and 60 months after diagnosis. Analyses were stratified by primary treatment. Racial/ethnic differences at each time point were assessed using Generalized Estimating Equations, adjusting for pretreatment function, age at diagnosis, secondary treatment, and other confounders. An adjusted summary score for each functional domain was calculated for each time period. RESULTS Patients included 1,475 non-Hispanic white, 321 African-American, and 279 Hispanic prostate cancer patients. After 60 months, among prostatectomy patients, African-Americans had significantly higher sexual function scores than non-Hispanic whites (43.9 v 36.1; P = .02), but were more likely to have a moderate to big problem with sexual function (50.6% v 44.4%; P = .04). African-Americans also had higher urinary function scores at 5 years than non-Hispanic whites (78.5 v 72.4; P = .04) and were less likely to have problems with incontinence. Changes in sexual and bowel function after radiotherapy showed no significant racial/ethnic differences. CONCLUSION This long-term cohort study found that, among prostatectomy patients, African-Americans had better recovery of sexual and urinary function at 60 months after diagnosis that was likely to be of mild clinical significance, despite reporting more problems with sexual function than non-Hispanic whites. More study is necessary to understand reasons for these differences. In contrast, no racial/ethnic differences in recovery from radiotherapy were found.
Collapse
Affiliation(s)
- Terri Kang Johnson
- University of Southern California Keck School of Medicine, Dept of Preventive Medicine, 1441 Eastlake Ave, Rm 3427A, MC9175, Los Angeles, CA 90089-9175, USA.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Caruso RP, Levinson B, Melamed J, Wieczorek R, Taneja S, Polsky D, Chang C, Zeleniuch-Jacquotte A, Salnikow K, Yee H, Costa M, Osman I. Altered N-myc downstream-regulated gene 1 protein expression in African-American compared with caucasian prostate cancer patients. Clin Cancer Res 2004; 10:222-7. [PMID: 14734473 DOI: 10.1158/1078-0432.ccr-0604-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE The protein encoded by N-myc downstream-regulated gene 1 (NDRG1) is a recently discovered protein whose transcription is induced by androgens and hypoxia. We hypothesized that NDRG1 expression patterns might reveal a biological basis for the disparity of clinical outcome of prostate cancer patients with different ethnic backgrounds. EXPERIMENTAL DESIGN Patients who underwent radical prostatectomy between 1990 and 2000 at Veterans Administration Medical Center of New York were examined. We studied 223 cases, including 157 African Americans and 66 Caucasians (T2, n = 144; >/=T3, n = 79; Gleason <7, n = 122; >/=7, n = 101). Three patterns of NDRG1 expression were identified in prostate cancer: (a) intense, predominately membranous staining similar to benign prostatic epithelium; (b) intense, nucleocytoplasmic localization; and (c) low or undetectable expression. We then examined the correlations between patients' clinicopathological parameters and different NDRG1 expression patterns. RESULTS In this study of patients with equal access to care, African-American ethnic origin was an independent predictor of prostate-specific antigen recurrence (P < 0.05). We also observed a significant correlation between different patterns of NDRG1 expression and ethnic origin. Pattern 2 was less frequent in African Americans (21% versus 38%), whereas the reverse was observed for pattern 3 (60% in African Americans versus 44% in Caucasians; P = 0.03). This association remained significant after controlling for both grade and stage simultaneously (P = 0.02). CONCLUSIONS Our data suggest that different NDRG1 expression patterns reflect differences in the response of prostatic epithelium to hypoxia and androgens in African-American compared with Caucasian patients. Further studies are needed to determine the contribution of NDRG1 to the disparity in clinical outcome observed between the two groups.
Collapse
Affiliation(s)
- Robert P Caruso
- Department of Urology, New York University Cancer Institute, Kaplan Comprehensive Cancer Center, New York, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Johnstone PAS, Williams SR, Riffenburgh RH. The 100-day PSA: usefulness as surrogate end point for biochemical disease-free survival after definitive radiotherapy of prostate cancer. Prostate Cancer Prostatic Dis 2004; 7:263-7. [PMID: 15289811 DOI: 10.1038/sj.pcan.4500736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Overall and biochemical disease-free (bNED) survival data after definitive radiotherapy (RT) for prostate cancer (CaP) requires decades of patient follow-up. Surrogates involving dynamics of prostate-specific antigen (PSA) decline, PSA nadir and time thereto have been unrewarding. This study investigated the metric of the PSA value 100 days after RT (PSA(100)), analyzed with respect to 8-y bNED survival. A total of 214 patients with T1-3 CaP were treated with definitive RT (defined as dose >66 Gy) in our institution between 1/1/1988 and 12/31/2000. All were subject to continuous follow-up with routine PSA levels. Biochemical failure (77 patients) was defined by the ASTRO criteria (n=67) or by the date of first hormonal therapy for a rising PSA, which did not meet the ASTRO criteria (n=10). No patients were included if they received postoperative radiation, or if hormones were administered prior to bNED recurrence, if any. Patients were stratified by PSA(100) values </= or >4.0 ng/ml, and </= or <2.5 ng/ml. Median follow-up was 64.3 months: follow-up data were calculated as of time to last PSA, with data collection as of 12/31/02. Patients with PSA(100)</=4.0 ng/ml had 62% 8-y bNED survival, and those with PSA(100)>4.0 ng/ml had 20% 8-y bNED survival (P<0.001). Use of a PSA(100) cutoff of 2.5 ng/ml yielded no significant difference in 8-y bNED survival (P=0.229). Cox proportional analysis revealed that initial PSA (P=0.006), stage (P=0.001) and PSA(100)</=4.0 ng/ml (P=0.002) were significantly related to bNED survival, but that age (P=0.887), race (P=0.500), RT dose (P=0.669), Gleason sum (P=0.091), and PSA(100)</=2.5 ng/ml (P=0.128) were not. In conclusion, PSA(100) using a cutoff of 4 ng/ml is a valuable and reliable surrogate for bNED survival after definitive RT, requiring less follow-up than other metrics. Patients with less values will have only about a 1 in 3 chance of bNED failure at 8 y.
Collapse
|
25
|
Neugut AI, Chen AC, Petrylak DP. The “Skinny” on Obesity and Prostate Cancer Prognosis. J Clin Oncol 2004; 22:395-8. [PMID: 14691129 DOI: 10.1200/jco.2004.11.973] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
26
|
Barrett WL, Kassing WM, Shirazi R. Efficacy of brachytherapy for prostate cancer in African Americans compared with Caucasians. Brachytherapy 2004; 3:30-3. [PMID: 15110311 DOI: 10.1016/j.brachy.2003.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Revised: 11/13/2003] [Accepted: 11/17/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the biochemical response to prostate brachytherapy between African Americans and Caucasians in a consecutive series of patients treated at a single institution. METHODS AND MATERIALS Between July 1995 and October 2001, 173 patients were treated with permanent (125)I seed implantation alone for presumed localized adenocarcinoma of the prostate. Twelve patients were African American and their biochemical response to treatment was compared with the 161 Caucasian patients. The patients were evaluated for biochemical recurrence according to the ASTRO consensus statement and for achieving and maintaining PSA nadirs of < or = 1.0, < or = 0.5, and < or = 0.2. Median pretreatment PSA level was 8 for the African American group and 6 for the Caucasian group. Median Gleason score for each group was 6 and no patients had palpable extraprostatic disease at the time of treatment. RESULTS None of the African American patients have experienced biochemical recurrence compared with 7.5% of the Caucasian patients (p=0.34). The percentage of African American patients achieving and maintaining a PSA level of < or = 1.0 was 83% compared with 89% for the Caucasian patients (p=0.61). PSA nadir of < or = 0.5 was achieved in 75% of the African American patients and 81% of the Caucasian patients (p=0.52) and 50% of the African American patients experienced PSA levels of < or = 0.2 compared with 59% of the Caucasian patients (p=0.88). CONCLUSION African American patients with prostate cancer have in general been reported to have worse prognosis compared with Caucasians. This series suggests similar outcome between African American and Caucasian patients treated with brachytherapy for prostate cancer.
Collapse
Affiliation(s)
- William L Barrett
- Division of Radiation Oncology, University of Cincinnati, Cincinnati, OH 45267-0757, USA.
| | | | | |
Collapse
|
27
|
Johnstone PAS, Riffenburgh RH, Moul JW, Sun L, Wu H, McLeod DG, Kane CJ, Martin DD, Kusuda L, Lance R, Douglas R, Donahue T, Beat MG, Foley J, Chung A, Soderdahl D, Do J, Amling CL. Effect of age on biochemical disease-free outcome in patients with T1-T3 prostate cancer treated with definitive radiotherapy in an equal-access health care system: a radiation oncology report of the Department of Defense Center for Prostate Disease Research. Int J Radiat Oncol Biol Phys 2003; 55:964-9. [PMID: 12605974 DOI: 10.1016/s0360-3016(02)04283-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE It has traditionally been a common perception that young age is a negative prognostic factor in prostate cancer (CaP). Furthermore, many urologists believe that younger patients are better suited to surgery rather than radiotherapy (RT) because of this perception. However, the data on the effect of age on outcome in patients with CaP are unclear. The records of the Department of Defense Center for Prostate Disease Research were queried for the biochemical disease-free results of patients after definitive RT and analyzed by age. MATERIALS AND METHODS The records of 1018 patients with T1-T3 CaP treated with definitive RT between 1988 and 2000 were reviewed. The records of patients receiving adjuvant hormonal therapy or adjuvant or salvage RT postoperatively were excluded. Biochemical failure was calculated by the American Society for Therapeutic Radiology and Oncology criteria. The median potential follow-up was 85.3 months as of December 31, 2001. RESULTS Age did not affect biochemical disease-free survival significantly when considered as <60 vs. >/=60 years (p = 0.646), by decade (p = 0.329), or as a continuous variable (correlation coefficient r = 0.017, regression slope = 0.007, with p = 0.588 and R(2) < 0.001). Using multiple regression analysis, age was still not significant (p = 0.408). Other variables analyzed were pretreatment prostate-specific antigen level (p < 0.001), Gleason sum (p = 0.023), stage (p = 0.828), and RT dose (p = 0.033). CONCLUSIONS Age and biochemical disease-free survival after RT for CaP are not related. Age may not be a valid factor in choosing between primary treatment options for CaP.
Collapse
|