This study assessed the effects of sociodemographic factors on the choice of prostatectomy as the first course of treatment for prostate cancer. Subjects were identified in the California Cancer Registry and included men diagnosed with prostate cancer between 1990 and 1993.

Black men were less likely than white men to undergo prostatectomy after adjusting for age, income, year and stage of diagnosis (OR=0.60, 95% confidence interval = 0.50 - 0.60). Hispanic men were somewhat less likely than white men to undergo this procedure (OR=0.90, 95% confidence interval = 0.90 - 1.00). Asian/Other men were equally likely as white men to undergo this procedure. Surprisingly, there appeared to be no detectable pattern by stage of diagnosis (Stage I/II versus Stages III/IV OR =1.00). Neighborhood income, but not neighborhood education, was associated with prostatectomy use for each racial group.

Treatment was considered not in accordance with the PDQ guidelines if a prostatectomy was performed on a patient who was either (1) diagnosed with stage III or IV prostate cancer, or (2) older than 70 years. Black men were 1.4 time more likely to receive treatment in concordance with the PDQ than white men (95% confidence interval = 1.3 – 1.5); Hispanic and Asian/Other men were equally likely as white men to receive appropriate treatment. The race effect (African Americans versus whites) was highest in the high-income neighborhoods.

The authors suggest that this treatment pattern might be due to differential access and/or inclination to seek health care between racial groups. The authors conclude that black men are receiving less aggressive treatment for prostate cancer, but this pattern may be to their benefit according to the PDQ.