ORLANDO — Men who have surgery to remove prostate cancer experience better long-term survival, compared with patients who have radiation therapy or watchful waiting, according to a retrospective study of African American and white men.
Researchers assessed survival in a cohort of 23,811 men diagnosed with prostate cancer enrolled in the HMO Cancer Research Network in which 12 health maintenance organizations nationwide participate.
This source of data has an advantage compared with previous, population-based studies that assessed possible racial differences in outcomes, said Dr. Gerald Y. Tan. “Comparisons using HMO data may control for treatment selection biases across racial groups. Black men have equal access to care when you use an HMO database versus a population database,” said Dr. Tan of the department of urology at New York Weill Cornell Medical Center, New York.
A total of 10,450 men chose watchful waiting for their prostate cancer management, 6,804 chose radical prostatectomy, and 6,557 chose radiation therapy.
The cohort comprised 3,613 African Americans, 17,345 whites, and 2,853 patients who reported their race as “other.” The researchers looked for differences between African American and white men.
A total of 44% of the African American and white men chose watchful waiting. In the remaining African American and white men, 30% and 28%, respectively, chose surgery, and 26% and 28% chose radiation.
Men treated with surgery lived longer than did men in the other two groups, Dr. Tan said at the annual meeting of the American Urological Association. After a mean follow-up of 6.6 years, 37% of the watchful waiting group, 15% of the surgery group, and 24% of the radiation group had died.
The prostate cancer-specific death rate was highest in the conservative treatment group, regardless of race, and better for African American men, compared with white men in the radiation and surgery groups, said Dr. Tan, who presented results on behalf of the principal investigator, Dr. Robert A. Leung, a urologist at the same institution. The retrospective design and unavailability of data regarding family history of prostate cancer were potential limitations of the study, Dr. Tan said.