Abstract
Objectives. To analyze the relationships among socioeconomic status (SES), race, and
the clinical parameters of patients undergoing radical prostatectomy (RP) in an equal
access health care system.
Methods. The Department of Defense Center for Prostate Disease Research longitudinal
prostate cancer database from multiple military institutions was used to analyze the
clinical, pathologic, and outcome data of 1058 patients with localized (Stage T2c
or lower) prostate cancer and a preoperative prostate-specific antigen (PSA) level
of 20 ng/mL or less who underwent RP between January 1987 and December 1997. Military
rank (officer versus enlisted) was used as a surrogate measure of SES.
Results. The percentage of patients with pathologic Gleason grade 7 or greater prostate
cancer was higher in enlisted (45%) than in officer (37%) patients (P = 0.021). However, no difference was found between these groups with respect to pathologic
stage or biochemical recurrence rates. African Americans presented at a younger age
(P = 0.003), with a higher pretreatment PSA level (P = 0.001), and demonstrated higher biochemical recurrence rates than other ethnic
groups (P = 0.037). The Cox proportional hazards analysis showed that a lower SES (P = 0.010) but not African American race (P = 0.696) was an independent predictor of a higher grade (Gleason grade 7 or higher)
cancer. However, biochemical progression was more common in African American men (P = 0.035) and was not related to SES (P = 0.883).
Conclusions. In an equal access health care system, patients of lower SES presented
with higher grade prostate cancer at the time of RP. However, only African American
race predicted biochemical progression after RP.
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Article info
Publication history
Accepted:
July 24,
2000
Received in revised form:
July 24,
2000
Received:
February 17,
2000
Footnotes
☆The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program, sponsored this report (No. S-98-031) as required by HSETCINST 6000.41A. This research was supported in part by a Center for Prostate Disease Research (CPDR) Program grant from the United States Army Medical Research and Material Command (USAMRMC) to the Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, and administered by the Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland.
Identification
Copyright
© 2000 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
