Non-white race, older age, and living in more impoverished counties predict a greater likelihood of being diagnosed with high-risk prostate cancer (PCa) and a decreased likelihood of receiving local PCa treatment, according to a recent study.
The study, led by Usama Mahmood, MD, of the University of Texas MD Anderson Cancer Center in Houston, found that blacks, Hispanics, and Asian/Pacific Islanders had a significant 42%, 23%, and 35% increased odds of having high-risk PCa at presentation, respectively, compared with whites. Each 1-year increase in age was associated with a significant 6% increased risk. In addition, compared with patients in the lowest quartile of county poverty rate, those in the highest quartile had a significant 13% increased odds, Dr. Mahmood’s group reported online ahead of print in The Journal of Urology.
Using the Surveillance, Epidemiology, and End Results (SEER) registry, the investigators identified 42,403 men diagnosed with localized PCa in 2010 who were assigned National Comprehensive Cancer Network (NCCN) risk based on clinical factors. The SEER registry recently released Gleason score at the time of biopsy or transuretheral resection of the prostate, which for the first time allows accurate assessment of the presentation and treatment of PCa according to clinical factors at diagnosis, the researchers pointed out.
Of the 42,403 men, 38%, 40%, and 22% had low-, intermediate-, and high-risk disease, respectively. Among 38,634 patients for whom PCa was the first malignancy, 23% received no local treatment, 40% underwent radical prostatectomy (RP), 36% had radiation treatment, and 1% had local tumor destruction (mostly cryotherapy).
Blacks were more likely to undergo radiation therapy than whites (42.5% vs. 34.7%) and less likely to undergo RP (33.7% vs. 42.3%). With increasing age, the use of radiation therapy increased and the use of RP decreased. Radiation use increased from 18.1% of patients younger than 55 years to 27.5% of patients aged 55 and older but younger than 65, 42.6% of those aged 65 and older but younger than 75, and 49.1% of men older than 75. In these respective age groups, RP use decreased from 67.2% to 53.7%, 33.9%, and 5.7%, respectively.
Additionally, the study showed that patients with intermediate-risk disease were more likely to receive local treatment and less likely to receive no treatment than those with high-risk disease (84.4% vs. 75.2% and 15.6% vs. 24.9%, respectively).
The authors noted that other studies have demonstrated differences in local treatment according to patient demographics and geography, but their study is unique in that they were able to demonstrate the variability in local treatment according to NCCN risk determined at clinical presentation.