Racial Differences in Treatment Decision-Making for Men with Clinically Localized Prostate Cancer: a Population-Based Study

Abstract

Purpose: Racial differences in prostate cancer treatment patterns have motivated concerns about over- and undertreatment. We surveyed black and white patients with localized prostate cancer (LPC) regarding their treatment decision-making processes to gain a better perspective on factors associated with LPC treatment choice.

Methods: We conducted a population-based, cross-sectional survey of 260 men (132 black, 128 white) aged ≤75 years, with newly diagnosed LPC. Our primary outcome was treatment choice (either surgery, radiation, or watchful waiting/active surveillance (WW/AS)), and our primary predictors were race and tumor risk level.

Results: Overall, treatment choice did not differ by race. As cancer risk increased, both black and white patients were more likely to undergo surgery and less likely to receive radiation. However, the pattern of WW/AS was different between white and black men. White men were less likely to select WW/AS as cancer risk increased, while risk level was unrelated to black men undergoing WW/AS. Urologist's recommendation had the greatest impact on men's treatment choice, followed by tumor risk level, age, and personal preferences.

Conclusions: Although there were no overall racial differences in treatment choice, when stratified by tumor risk level, the pattern of WW/AS was different between white and black patients, suggesting that over- and undertreatment is a larger concern for black than white men. A risk-stratified approach to understand racial disparities in LPC treatment and better strategies to aid black men in their treatment decision-making are needed to reduce racial disparities in prostate cancer outcomes.

Keywords: Active surveillance/watchful waiting; Prostate cancer; Prostatectomy; Racial differences; Radiation; Treatment decision-making.

Fig. 1

Determination of study sample

Fig.2

Racial comparisons of treatment patterns by tumor risk level. Note: Percent is calculated as percent of total for that race within each risk level (i.e., low-, intermittent-, and high-risk). Int Risk intermittent risk