Impact of socioeconomic status and race on clinical parameters of patientsundergoing radical prostatectomy in an equal access health care system

Objectives. To analyze the relationships among socioeconomic status (SES), race, and the clinical parameters of patients undergoing radical prostatect omy (RP) in an equal access health care system. Methods. The Department of Defense Center for Prostate Disease Research lon gitudinal prostate cancer database from multiple military institutions was used to analyze the clinical, pathologic, and outcome data of 1058 patients with localized (Stage T2c or lower) prostate cancer and a preoperative pro state-specific antigen (PSA) level of 20 ng/mL or less who underwent RP bet ween January 1987 and December 1997. Military rank (officer versus enlisted ) was used as a surrogate measure of SES. Results. The percentage of patients with pathologic Gleason grade 7 or grea ter prostate cancer was higher in enlisted (45%) than in officer (37%) pati ents (P = 0.021). However, no difference was found between these groups wit h respect to pathologic stage or biochemical recurrence rates, African Amer icans presented at a younger age (P = 0.003), with a higher pretreatment PS A level (P = 0.001), and demonstrated higher biochemical recurrence rates t han other ethnic groups (P = 0.037). The Cox proportional hazards analysis showed that a lower SES (P = 0.010) but not African American race (P = 0.69 6) was an independent predictor of a higher grade (Gleason grade 7 or highe r) cancer. However, biochemical progression was more common in African Amer ican men (P = 0.035) and was not related to SES (P = 0.883). Conclusions. In an equal access health care system, patients of lower SES p resented with higher grade prostate cancer at the time of RP. However, only African American race predicted biochemical progression after RP. UROLOGY 56: 1016-1020, 2000. Published by Elsevier Science Inc.