Racial/Ethnic Disparities in the Treatment of Prostate Cancer Among Men Age 55 Years and Younger

Younger men diagnosed with prostate cancer are more likely to die of their disease than older men. Furthermore, the treatment they receive may significantly impact survival, with surgery associated with better survival than either radiation or active surveillance (the cancer is monitored but no treatment is given). Black-White and Hispanic-White disparities in prostate cancer treatment and survival have been reported based on analyses of samples that aggregate across age groups; however, little is known about racial/ethnic disparities in how younger men are treated, for whom the impact of such disparities on survival may be particularly great.

Objective: The objective of this study was to evaluate racial/ethnic differences in use of specific prostate cancer treatment modalities in men ≤ 55 years of age.

Method: Data for the study were obtained from the SEER Tumor Registry (2004-2007). The sample included all men ≤ 55 who were diagnosed with clinically localized prostate cancer during that period. Logistic and multinomial regression analysis were performed to determine the odds ratio (OR) of receiving definitive treatment over active surveillance and relative risk ratio (RRR) of either Blacks or Hispanics receiving a specific treatment modality over active surveillance compared to Whites receiving the same treatment over active surveillance. Regression analyses were adjusted for age at diagnosis, marital status, cancer grade, and cancer stage.

Results: Blacks and Hispanics had higher risk disease than Whites as evidenced by higher mean PSA levels among Blacks (9.79, p<0.001) and Hispanics (9.27, p<0.003) than Whites (8.06); and higher proportion of intermediate grade cancers in Blacks (40.29%) than Hispanics (34.25%, p<0.001) and Whites (36.39%, p<0.001); and high grade cancers in Blacks (8.53%) than Whites (7.51%, p<0.05). Despite this, Blacks (OR=0.74; 95%CI=0.66°ª0.83) and Hispanics (OR=0.78; 95%CI=0.67-0.91) had an overall lower odds of receiving definitive therapy (surgery or radiation). Compared to Whites, Blacks (0.61, 95%CI=0.54-0.68) and Hispanics (0.77, 95%CI=0.66-0.89) had a significantly lower RRR of receiving surgery over active surveillance. Hispanics had a lower (0.77, 95%CI=0.61-0.97) and Blacks had a higher RRR (1.43, 95%CI=1.22-1.67) of receiving radiation over active surveillance compared to Whites.

Discussion: Despite evidence that younger men are more likely to die from prostate cancer and receive greater benefit from definitive treatment (especially from surgery), results suggest that racial/ethnic disparities exist among men ≤ 55 years. Black and Hispanic men were less likely to receive definitive treatment overall and, compared to Whites, had a lower RRR of receiving surgery over active surveillance.