RE: Racial Differences in Mortality Among Medicare Recipients After Treatment for Localized Prostate Cancer

Extract

The recent article by Godley et al. (1) raises important concerns for those who manage localized prostate cancer. The authors found that African Americans who underwent surgery, radiation, or non-aggressive therapy for localized prostate cancer had a median overall survival that was 1.8, 0.7, and 1.0 years less than that of Caucasians treated with the same respective modality. Moreover, a significant disadvantage in overall survival was seen in African American surgical patients after adjusting for age, comorbidity score, stage, cancer grade, SEER¹ site, and race-specific census tract level measures of education and income. Although the multivariable analysis was limited by the exclusion of serum prostate-specific antigen (PSA) level, one must still question why African American men have a 23% greater adjusted risk of death after surgical treatment, a therapy that is generally unavailable to the elderly population and those with significant comorbidities.

Also disturbing were the observations that a higher proportion of African Americans (38%) than Caucasians (27%) underwent non-aggressive treatments and that a smaller proportion of African Americans (24%) than Caucasians (33%) were treated with very aggressive therapy (i.e., surgery). These results are surprising because, when compared with Caucasians, a larger proportion of African Americans were less than 70 years of age (37% versus 34%) and were treated in the more recent era of widespread PSA use (59% versus 51%). These findings may relate to population differences in overall health, but it is important to consider possible reasons why African American men may be offered or select less aggressive therapies.