Objective
We sought to evaluate the impact of socioeconomic status (SES) on the likelihood of
undergoing radical prostatectomy (RP) or external beam radiation therapy (XRT) and
the ensuing effect on cancer-specific survival (CSS) after treatment for men with
low-risk prostate cancer.
Methods
Using the California Cancer Registry database, we identified 123,953 men diagnosed
with localized, Gleason ≤7 prostate cancer from 1996 to 2005. Patients were separated
into quintiles based on socioeconomic status and were stratified by race, age, year
of diagnosis, and treatment. Logistic regression and Kaplan-Meier analyses were used
to determine the likelihood of undergoing RP or XRT and cancer-specific survival.
Results
In the final cohort, 39,234 patients (31.7%) and 42,431 patients (34.3%) underwent
RP and XRT as initial therapy. Men of lower SES were less likely to undergo RP or
XRT. Men undergoing RP in the lowest SES were twice as likely to die of prostate cancer
(HR 1.99, 95% CI 1.28-3.09, P = .002) than men in the highest SES. This difference was even more profound when
adjusted for race (HR 2.20, 95% CI 1.38-3.50, P = .001). Similarly, men in the lowest SES who underwent XRT were also approximately
twice as likely to die of prostate cancer (HR 2.24, 95% CI 1.71-2.94, P <.001) than men of the highest SES, regardless of race.
Conclusions
Men of lower SES are less likely to undergo RP or XRT for the management of localized
prostate cancer. After RP or XRT, men of lower SES have a decreased cancer-specific
survival compared with men of higher SES.
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Article info
Publication history
Published online: October 01, 2010
Accepted:
March 5,
2010
Received:
June 18,
2009
Identification
Copyright
© 2010 Published by Elsevier Inc.
