Racial disparity seen in prostate cancer treatment

Black men with early prostate cancer may be less likely to receive aggressive treatment than their white counterparts, a small study has found.

The reason, researchers say, seems to be that doctors are somewhat less likely to offer extensive surgery or radiation treatment to black patients - and not that black patients more often refuse more-aggressive treatment.

The study found that of 79 African-American men with earlier-stage prostate cancer, 71 percent received what is considered to be more-aggressive treatment - surgical removal of the prostate gland or radiation therapy.

That compared with 82 percent of 158 white patients, the researchers report in the journal Urology.

Black men were about as likely to accept treatment as white men - about 10 percent refused, versus 8 percent of white men. But while doctors offered prostate removal or radiation to white men 91 percent of the time, they offered it to black men in 85 percent of cases.

Dr. Kathryn E. Richert-Boe, of Kaiser Permanente Northwest in Portland, Oregon, led the study.

Because prostate cancer is often slow-growing, early-stage cancer is not always treated immediately with surgery or radiation. In fact, "watchful waiting" - where a doctor monitors the progression of the cancer - can be a better option in cases where the risks and side effects of treatment may outweigh the benefits.

Men who are elderly or in poor general health and those whose tumors seem to be particularly slow-growing may be advised to take the wait-and-see approach.

Richert-Boe and her colleagues looked at whether age, overall health and tumor grade - a measure of a cancer's aggressiveness - explained the racial disparity. They did not.

Nor did differences in insurance coverage since all of the men were part of the same health plan.

For now, the reasons for the findings are unclear, according to Richert-Boe's team. The researchers got their information from patients' medical records, which, they note, "may not always completely reflect the reasoning of medical care providers or their patients."

Larger studies, the researchers conclude, are needed to uncover the reasons for racial disparities in prostate cancer treatment.

SOURCE: Urology, June 2008.