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Men of Higher Socioeconomic Status Have Improved Outcomes After Radical Prostatectomy for Localized Prostate Cancer

  • Nicholas J. Hellenthal
    Correspondence
    Reprint requests: Nicholas J. Hellenthal, M.D., Department of Urology, UC Davis Medical Center, 4860 Y Street, Suite 3500, Sacramento, CA 95817
    Affiliations
    Department of Urology, University of California, Davis Medical Center, Sacramento, California; and the California Cancer Registry, Sacramento, California
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  • Arti Parikh-Patel
    Affiliations
    Department of Urology, University of California, Davis Medical Center, Sacramento, California; and the California Cancer Registry, Sacramento, California
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  • Katrina Bauer
    Affiliations
    Department of Urology, University of California, Davis Medical Center, Sacramento, California; and the California Cancer Registry, Sacramento, California
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  • W. Ralph
    Affiliations
    Department of Urology, University of California, Davis Medical Center, Sacramento, California; and the California Cancer Registry, Sacramento, California
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  • White deVere
    Affiliations
    Department of Urology, University of California, Davis Medical Center, Sacramento, California; and the California Cancer Registry, Sacramento, California
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  • Theresa M. Koppie
    Affiliations
    Department of Urology, University of California, Davis Medical Center, Sacramento, California; and the California Cancer Registry, Sacramento, California
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Published:October 01, 2010DOI:https://doi.org/10.1016/j.urology.2010.03.024

      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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      References

        • Jemal A.
        • Clegg L.X.
        • Ward E.
        • et al.
        Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival.
        Cancer. 2004; 101: 3-27
        • Evans S.
        • Metcalfe C.
        • Ibrahim F.
        • et al.
        Investigating Black-White differences in prostate cancer prognosis: A systematic review and meta-analysis.
        Int J Cancer. 2008; 123: 430-435
        • Du X.L.
        • Fang S.
        • Coker A.L.
        • et al.
        Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort.
        Cancer. 2006; 106: 1276-1285
        • Krupski T.L.
        • Kwan L.
        • Afifi A.A.
        • et al.
        Geographic and socioeconomic variation in the treatment of prostate cancer.
        J Clin Oncol. 2005; 23: 7881-7888
        • California Cancer Registry
        (CdoPH Cancer Surveill Res Branch, April;2008:1988, released April 2008)
        • Yost K.
        • Perkins C.
        • Cohen R.
        • et al.
        Socioeconomic status and breast cancer incidence in California for different race/ethnic groups.
        Cancer Causes Control. 2001; 12: 703-711
        • Robbins A.S.
        • Yin D.
        • Parikh-Patel A.
        Differences in prognostic factors and survival among White men and Black men with prostate cancer, California, 1995-2004.
        Am J Epidemiol. 2007; 166: 71-78
        • Sanderson M.
        • Coker A.L.
        • Perez A.
        • et al.
        A multilevel analysis of socioeconomic status and prostate cancer risk.
        Ann Epidemiol. 2006; 16: 901-907
        • Sultan R.
        • Slova D.
        • Thiel B.
        • et al.
        Time to return to work and physical activity following open radical retropubic prostatectomy.
        J Urol. 2006; 176: 1420-1423
        • Chan J.K.
        • Zhang M.
        • Hu J.M.
        • et al.
        Racial disparities in surgical treatment and survival of epithelial ovarian cancer in United States.
        J Surg Oncol. 2008; 97: 103-107
        • Crawley L.
        • Payne R.
        • Bolden J.
        • et al.
        Palliative and end-of-life care in the African American community.
        J Am Med Assoc. 2000; 284: 2518-2521
        • Swindle P.
        • Eastham J.A.
        • Ohori M.
        • et al.
        Do margins matter?.
        J Urol. 2005; 174: 903-907
        • Kupelian P.A.
        • Ciezki J.
        • Reddy C.A.
        • et al.
        Effect of increasing radiation doses on local and distant failures in patients with localized prostate cancer.
        Int J Radiat Oncol Biol Phys. 2008; 71: 16-22
        • Mangar S.A.
        • Huddart R.A.
        • Parker C.C.
        • et al.
        Technological advances in radiotherapy for the treatment of localised prostate cancer.
        Eur J Cancer. 2005; 41: 908-921