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Treatment for Older Prostate Cancer Patients: Disparities in a Southern State

Pisu, Maria PhD*; Oliver, JoAnn S. PhD; Kim, Young-Il PhD*; Elder, Keith PhD; Martin, Michelle PhD*; Richardson, Lisa C. MD, MPH§

doi: 10.1097/MLR.0b013e3181eb31a8
Original Article

Background: Black prostate cancer patients are less likely to receive aggressive therapy (AT) than Whites: reported rates for patients ≥65 years old are about 55% versus 65%. Little is known about treatment rates in socioeconomically deprived states with large Black populations like Alabama.

Study Design: Medicare claims and Alabama Statewide Cancer Registry records were linked for Alabamian men in Medicare fee-for-service diagnosed with loco-regional prostate cancer in 2000–2002. The association between race and likelihood of: (1) AT (prostatectomy or external beam radiation therapy [EBRT] or brachytherapy); (2) hormone therapy (primary androgen deprivation therapy [ADT] or orchiectomy); (3) <30 days of EBRT; and (4) <6 months of ADT, was investigated adjusting for age, clinical tumor stage, grade, Comorbidity Index, and census tract proportion of Black residents, of persons living below poverty and with ≤ high school.

Results: Of 3561 patients, 71.2% received AT and 38.3% hormone therapy. Blacks were less likely to receive AT (64.3% vs. 73.0%, adjusted [adj.] OR: 0.80, CI: 0.67–0.96). There was no difference between Blacks and Whites in the likelihood of receiving hormone therapy (40.8% vs. 37.7%, adj. OR: 1.10, CI: 0.91–1.34), <30 days of EBRT (30.5% vs. 31.5%, adj. OR: 0.98, CI: 0.72–1.32) or <6 months of ADT (50.7% vs. 54.0%, adj. OR: 0.84, CI: 0.63–1.12).

Conclusions: In Alabama, there were racial differences in utilization of aggressive treatment for locoregional prostate cancer. Research should investigate factors associated with prostate cancer treatment among older men, such as patient behavior and access to care.

From the *Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL; †Capstone College of Nursing, University of Alabama, Tuscaloosa, AL; ‡Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL; and §Division of Cancer Prevention and Control, NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA.

Supported by Cooperative Agreement U48 DP000225–01 from the Centers for Disease Control and Prevention's Prevention Research Centers Program.

“The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.”

Reprints: Maria Pisu, PhD, Division of Preventive Medicine, The University of Alabama at Birmingham, 1530 3rd Ave South, MT 634, Birmingham, AL 35294–4410. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.