TRENDS AND BLACK WHITE DIFFERENCES IN TREATMENT FOR NONMETASTATIC PROSTATE-CANCER/

OBJECTIVES. Controversy and uncertainty surround use of radical prosta tectomy, radiation therapy, and conservative symptomatic management in treating elderly men with nonmetastatic prostate cancer. Prior studie s have demonstrated variations in use of these therapies by patient ag e, race, and geographic region. This study examined trends in treatmen t for nonmetastatic prostate cancer in black and white men aged 65 and older during the period 1986 to 1993. The study also explored factors related to use of initial therapies in these men. METHODS. A cohort o f 52,915 men (48,410 white; 4,505 black) obtained from the linked SEER -Medicare dataset was used in an observational design. Various sociode mographic and clinical measures were incorporated in the analysis. RES ULTS. For both races, use of aggressive therapy had increased with tim e, although this trend appears to be slowing. Black men were less like ly to undergo radical prostatectomy than were white men, but use of ra diation therapy did not differ markedly by race. High socioeconomic st atus and a lack of comorbid conditions were among the factors predicti ve of aggressive therapy receipt. The relation between race and receip t of aggressive therapy was dependent on whether prostate cancer was d etected by transurethral resection of the prostate. Sociodemographic a nd clinical characteristics explained approximately half the differenc e between black men and white men in radical prostatectomy use. CONCLU SIONS. This study documents racial differences and changing practice p atterns in the treatment of nonmetastatic prostate cancer in elderly m en. Further research is required to more fully understand reasons for racial differences, as well as to promote rational use of health care resources.