The purpose of this study was to compare stage-specific treatment among black and white prostate cancer patients residing in Connecticut. A previous analysis found the radical prostatectomy rate was lower for black than white men aged 65 to 69 years, but stage at diagnosis data were not available. Another previous study of Medicare beneficiaries found bilateral orchiectomy was more than twice as frequent in blacks than whites; however, again stage at diagnosis was not available.

Data for this study were derived from the Connecticut SEER registry for the period from 1988 to 1992. Socioeconomic status was defined as the poverty rate of the census tract of the patient’s residence, using census data. Analyses were stratified by local/regional stage diagnoses and distant (metastatic) stage diagnoses.

Among patients with local/regional stage diagnoses, radical prostatectomy was less frequent in blacks than whites diagnosed less than 65 years (50.4% of 1038 whites versus 41.6% of 164 blacks) and less frequent in blacks than whites diagnosed between 65 and 74 years (23.1% of 2689 whites versus 18.9% of 164 blacks). This procedure was infrequent among patients older than 75 years at diagnosis for both race groups. In a logistic regression model that included only age and race, both variables significantly predicted radical prostatectomy. After adjusting for SES of census tract, the race difference was no longer statistically significant.

Among distant-stage patients, neither race nor SES significantly predicted endocrine surgery (47.1% of the 150 blacks versus 41.3% of the 1128 whites).

The author concludes that the negative association between radical prostatectomy among patients with local/regional stage cancers could “reflect the cost of surgery.” He also concluded that “the finding that race was not significantly associated with endocrine surgery among patients with distant stage cancer suggests that the higher rates of orchiectomy in black patients compared with white patients (in previous studies) are due largely to confounding between race and stage at diagnosis rather than to differential treatment by race of clinically comparable patients.” Finally, he noted that “explaining the later stage at diagnosis of prostate cancer and the higher incidence rates for blacks versus whites should be a major research priority.”