Racial/ethnic disparities in prostate cancer initial treatment selection in Florida

Background: Racial/ethnic disparities exist in the detection, treatment, and mortality of localized prostate cancer (LPC). The objective of this study was to see if the racial/ethnic differences in initial treatment of LPC are explained by sociodemographic and clinical factors. Methods: The Florida Cancer Data System was used to obtain data from men (n=83,223) diagnosed with LPC between the years 2001 and 2009 of which 75% were non-Hispanic White (White), 13% non-Hispanic Black (Black), 12% Hispanic and 1% non-Hispanic Other (Other) and whose initial treatment was surgery (34%), radiation (32%), hormonal (22%) or watchful waiting (WW) (12%). US Census data was used to construct area-based socioeconomic measures of education and SES. Univariate and multivariate polytomous logistic regression models were fitted to initial treatment with race/ethnicity as the main predictor. The models were adjusted for age at diagnosis, insurance, education, marital and smoking status, SES, urban/rural residence and tumor grade. Results: Black men were less likely to select radiation (OR:0.71; 95%CI: 0.66–0.76), surgery (OR:0.76; 95%CI: 0.71–0.81), or hormonal therapy (OR:0.77; 95%CI: 0.72.–0.83) over watchful waiting when compared to White men. In the adjusted models the associations remained for radiation (OR:0.85; 95%CI:0.79–0.91) and surgery (OR:0.66; 95%CI: 0.61–0.71). Conclusions: Black men were less likely to receive definitive therapy when compared to White men. After controlling for tumor aggressiveness and other sociodemographic factors, the likelihood of receiving surgery decreased by 13%. More research is warranted to determine the contribution of racial/ethnic factors in the initial treatment selection of LPC.