Race, Marriage Influence Prostate Cancer Treatment

Both help men decide whether to opt for surgery or radiation, study suggests

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By
HealthDay Reporter

MONDAY, March 28, 2005 (HealthDayNews) -- Surgery to remove the prostate and radiation therapy are the two recommended treatments for prostate cancer, but a man's race and marital status appear to influence which of these treatments he will ultimately prefer, researchers find.

Blacks are more likely to choose radiation therapy, while whites more often opt for invasive surgery to eradicate prostate cancer, according to a new study. It also found that single men are more likely to undergo radiation compared to married men, who are more likely to choose surgery to fight their disease.

Despite these differences in treatments, all groups studied ended up receiving equal levels of care, according to the report in the March 28 online edition of Cancer.

"We looked at men over 65, white, black and Hispanic," said lead author Dr. Thomas Denberg, an assistant professor at the University of Colorado and Health Sciences Center, both in Denver. All of the men had been diagnosed with early stage prostate cancer.

In its study, Denberg's team collected data on nearly 28,000 men registered in the Surveillance, Epidemiology, and End Results (SEER) cancer database. "We wanted to see what treatment these men received," he said.

The researchers found that, for all groups, access to curative therapy was equal. However, "African-Americans were significantly less likely to get prostatectomy as a form of curative treatment," Denberg said. About 14 percent of blacks underwent surgery compared with 22 percent of whites. Among Latinos, 28 percent underwent surgery, according to the study.

"Being married also seems to be associated with higher rates of receiving curative therapy," Denberg said. In addition, married men were more likely to undergo surgery than radiation, he noted.

As to why these trends exist, Denberg said, it's impossible to know for sure. He speculates that two factors -- what doctors recommend, and patient differences -- may be at play. "Most likely, it's a combination of both," he said.

Denberg noted that "African-Americans as a group tend to be more fearful of surgery, or perhaps more distrustful of physicians. There may be issues related to impotence. African-Americans are more worried about impotence as a side effect of surgery," Denberg suggested. It's also possible that doctors are stereotyping their patients and not presenting all the treatment options, he added.

As far as marriage is concerned, Denberg believes married men are getting more input about treatment from their wives. "Wives tend to think that surgery is the better option," he said. "There is this notion that you are 'getting the thing out,' whereas with radiation it's invisible and [there is] a lack of certainty from the lay person's perspective."

Denberg is quick to point out that there is no basis for preferring surgery over radiation. Both treatments appear to be equally successful, he said.

The findings suggest doctors should "pay more attention" to patient factors such as race or marital status "if we want to maximize the ability of people to participate in their own care decisions," Denberg said.

These findings are not true of prostate cancer alone, said Dr. Herman Kattlove, a medical oncologist and spokesman for the American Cancer Society. "It's true of all disease."

Married men may also be more likely to have surgery because there is someone to help them recuperate afterwards, Kattlove pointed out. "You need help in recovering from surgery."

In terms of African-Americans, Kattlove agreed that they tend to be less trustful of doctors. "My experience in dealing with African-American patients is that they didn't trust the system, they didn't trust doctors."

Kattlove thinks there is no demonstrated difference in results between surgery and radiation for prostate cancer. However, "people tend to favor surgery because they want to get the cancer out. It's much more concrete than to depend on the effect of some unknown, magical principle of radiation," he said.

Side effects of surgery are seen immediately, while those from radiation may take longer to develop, Kattlove said. "After surgery men are impotent, incontinent, but some of that gets better in time; whereas, after radiation men do fine, but the effect of radiation begins to tell after a year or two. When you look at impotence rates [of both treatments], they are about the same after a couple of years."

More information

The American Cancer Society can tell you more about prostate cancer.

SOURCES: Thomas Denberg, M.D., Ph.D., assistant professor, University of Colorado and Health Sciences Center, both in Denver; Herman Kattlove, M.D., M.P.H., medical oncologist, spokesman, American Cancer Society, Atlanta; March 28, 2005, online edition, Cancer

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