White men with prostate cancer more likely to receive definitive therapy than black men

White men appeared more likely than black men to receive definitive therapy for prostate cancer, according to findings published in European Urology.

“It is well established that prostate cancer incidence and overall outcomes remain worse for black men,” David F. Friedlander, MD, MPH, clinical fellow in surgery at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “Differences between white and black men with regards to sociodemographic factors, cultural beliefs and intrinsic cancer biology have all been proposed as explanations for the aforementioned racial disparities. However, few if any studies have evaluated racial disparities in delivering definitive therapy for clinically localized prostate cancer at the facility level.”

The researchers used the National Cancer Data Base to identify 22,873 white men and 59,262 black men aged 40 years or older who received treatment for intermediate-risk or high-risk prostate cancer between January 2004 and December 2013.

Friedlander and colleagues performed multilevel logistic regression to predict the likelihood that patients would receive definitive therapy, with sensitivity and subgroup analyses to adjust for differences between patients and differences among facilities.

Overall, 83% of white men (n = 185,647) and 74% of black men (n = 43,662) received definitive therapy. The rates of definitive therapy increased in both races during the study period (81% vs. 83%; P < .001 for white patients; 73% vs. 75%; P = .001 for black patients).

However, among the treatment facilities included in the study, 39% showed significantly higher rates of definitive therapy for white men, whereas only 1% favored black men.

The researchers acknowledged that the retrospective nature limited the study, which may have predisposed the results to selection bias, and the fact that significant sociodemographic differences between white and black men may have produced effect modification.

“After adjusting for sociodemographic and clinical factors, we found significant facility-level variation in the rates of definitive therapy for localized prostate cancer among white and black men, with most Commission on Cancer facilities favoring definitive therapy in whites,” the researchers wrote. “These findings have major implications for ongoing efforts by federal health care agencies and national cancer organizations aimed at reducing racial disparities in both overall treatment rates and outcomes. Ultimately, such variation may partially account for the inferior survival data noted among black men receiving care for prostate cancer.” – by Andy Polhamus

Disclosures: Friedlander reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.