TREATMENT OF LOCALIZED PROSTATE-CANCER IN AFRICAN-AMERICAN COMPARED WITH CAUCASIAN MEN - LESS USE OF AGGRESSIVE THERAPY FOR COMPARABLE DISEASE

The objective of this study is to evaluate differences in treatment fo r localized prostate cancer in African-American compared with Caucasia n men. A cohort of patients was identified from the 1988-1989 Surveill ance, Epidemiology, and End Results data base. Data were linked by cou nty of residence to the Area Resource File. The main outcome measures were (1) the receipt of aggressive therapy (radical prostatectomy or e xternal beam radiation) and (2) the treatment modality (radical prosta tectomy or external beam radiation). Of 5,786 subjects, 15% were treat ed with a radical prostatectomy, 29% received external beam radiation, and 56% did not receive aggressive therapy. African Americans were le ss likely (relative risk 0.46; 95% confidence interval 0.39, 0.54) tha n Caucasians to receive aggressive therapy. Among those receiving aggr essive therapy, African Americans were less likely (relative risk 0.64 ; 95% confidence interval 0.48, 0.86) than Caucasians to have a radica l prostatectomy. Adjustment for patient, disease, and community health care availability characteristics did not change these results. We co nclude that African-American and Caucasian men receive different treat ments for localized prostate cancer. The reasons for the differences, and their ultimate effect on mortality and quality of life require fur ther study.