TREATMENT OPTIONS, SELECTION, AND SATISFACTION AMONG AFRICAN-AMERICANAND WHITE MEN WITH PROSTATE CARCINOMA IN NORTH-CAROLINA

BACKGROUND. In the U.S., prostate carcinoma mortality is greatest amon g African Americans. In North Carolina, the state with the fourth larg est population of African Americans, the prostate carcinoma mortality rate is 2.5 times greater among African Americans than among whites an d is the highest reported rate for any state in the nation. To explore potential reasons for the racial differential in mortality, a study w as undertaken to determine whether differences related to treatment ex isted between African American and white men who were diagnosed with p rostate carcinoma during the period 1994-1995. METHODS, Cases were sel ected from 16 institutions within a region comprising 63 contiguous co unties where the overall population was >20% African American. A strat ified design was employed to accrue subjects into groups of even size according to race and disease stage (n = 231). A telephone survey was conducted, which assessed treatment options discussed by patients with their physicians, treatment(s) received, factors influencing treatmen t, satisfaction with treatments discussed and options given, and socio demographic information. RESULTS. All measures related to treatment we re consistently associated with stage at diagnosis (P < 0.001) rather than other variables measured (i.e., race, age, income, comorbidity, e ducation, and residential status). Furthermore, most subjects reported that their physicians presented several treatment options (65%), that they were satisfied with the options presented (90%), and that the ph ysician was the most important factor influencing their treatment deci sion (57%). CONCLUSIONS. These data suggest that African American and white men in North Carolina receive comparable treatment for prostate carcinoma. Therefore, efforts to reduce the racial disparity in mortal ity should be directed toward lessening the high incidence of later st age disease at diagnosis and exploring potential biologic differences that may increase the risk of more aggressive disease among African Am ericans. (C) 1998 American Cancer Society.