“This study compares radical prostatectomy rates by race among male Medicare patients in New York. A retrospective analysis was conducted of all radical prostatectomies performed on hospitalized male Medicare beneficiaries for the period 1991 through 1993….Lower rates of radical prostatectomies were observed for all African Americans in all age groups except the <65-year-old age group…Local disease was found at the time of diagnosis in 70% of whites but in only 55% of African Americans. These data reflect later stage at diagnosis among African-American males.”

“These results indicate that despite higher national rates for prostate cancer, male African-American Medicare patients in New York have reduced access to radical prostatectomy as a treatment modality. This is especially of importance in the <70-yeaar-old age group in whom most authorities consider the procedure appropriate.”

“The higher mortality for African Americans is thought to be related to stage of disease at the time of diagnosis.”

“Polednak and Flannery, using a population-based cancer registry in Connecticut, found a higher rate of metastatic disease at diagnosis in African Americans (35.4%) compared with whites (22.1%). They also found that for localized disease, there was a significantly lower use of prostatectomy in African Americans compared with whites in patients lower than 70 years…Polednak and Flannery offer three explanations for these findings: longer patient delay between the times that symptoms appear and medical care is sought, lower screening rates and less chance of early detection in African Americans, and African-Americans/white differences in tumor biology or other factors influencing tumor progression.

“It is reasonable to assume that the significantly lower radical prostatectomy rates for African Americans observed in the present study reflect to some degree inoperable later stage at diagnosis. However, this in turn may be due to both poorer quality of care and unequal access to screening for African Americans.”

“Kahn, et al. recently showed that race and poverty influence access to care even among those who are insured. They also demonstrated that race characteristics and poverty influence the quality of care received by insured patients after they have gained access to the hospital. As Ayanian has observed, “Racial and socioeconomic disparities in medical care persist across a wide range of hospitals, even when patients are insured or have access to free care.”

“Given these findings, late stage at diagnosis with prostate cancer in African Americans must be viewed as due in part to poor quality of care and access problems and not solely to a failure to seek care.”