Predictors of aggressive therapy for nonmetastatic prostate carcinoma in Massachusetts from 1998 to 2002

Abstract

BACKGROUND: Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE: We sought to compare the proportions of black and white men receiving aggressive therapy for newly diagnosed nonmetastatic prostate cancer between 1998 and 2002, accounting for the clustering of outcomes by facility. METHODS: We used the Massachusetts Cancer Registry of all cancer diagnosed in residents of Massachusetts. We used logistic regression, clustering by the facility where the tumor was diagnosed, to predict the probability that a patient would receive any aggressive therapy, and the specific therapeutic choices of radical prostatectomy, external-beam radiation therapy, and brachytherapy. Predictors included race, age, poverty, insurance status, marital status, year of diagnosis, and tumor grade. RESULTS: Black men were similarly likely to receive aggressive therapy compared with white men (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.62-1.01). However, there was a racial difference in the receipt of particular types of therapy: black men were significantly more likely to receive radiation therapy (OR 1.39, 95% CI 1.16-1.68) and less likely to receive radical prostatectomy (OR 0.53, 95% CI 0.38-0.74). CONCLUSIONS: Among men diagnosed with nonmetastatic prostate cancer in Massachusetts from 1998 to 2002, black men received aggressive therapy at rates approaching those of whites. However, they were more likely to receive radiation therapy and less likely to receive radical prostatectomy.