Kim Fernando J, Werahera Priya N, Sehrt David E, Gustafson Diedra, Silva Rodrigo D, Molina Wilson R
Denver Health Medical Center, Denver, Colorado, USA.
Can J Urol. 2014 Jun;21(3):7305-11.
Our safety net hospital offers minimally invasive, traditional open and perineal radical prostatectomies, as well as radiation therapy and medical oncological services when appropriate. Historically, only few African American and Hispanic patients elected surgical procedures due to unknown reasons. Interestingly, after initiation of the prostate cryoablation program (Whole Gland) in 2003 at Denver Health Medical Center (DHMC) we noticed a trend towards cryotherapy in these specific patient populations for the treatment of localized prostate cancer. We analyzed the profile of ethnic minority men evaluated for localized prostate cancer and evaluated the associated factors in the decision making for the treatment of localized prostate cancer.
A retrospective review of 524 patients seen for prostate cancer from January 2003 to January 2012 in our safety net hospital was conducted. The treatment selected by the patient after oncologic consultation was then recorded. The health insurance status, demographic data, and personal statements of reasons for elected procedure were obtained. A multivariate logistic regression for associated factors influencing treatment decisions was then formed. Patients were categorized by using the D'Amico risk stratification criteria.
The insurance status revealed that only 1% of African American patients had private health insurance versus 5% Hispanic and 26% of Caucasians. African American men were at higher D'Amico risk with more positive metastasis evaluation yet were less likely to undergo surgery and instead often elected for radiation therapy. Conversely, Hispanic and Caucasian men often elected cryoablation and radical prostatectomy for their treatment. Referrals for surgery were primarily Caucasian males with private health insurance. Most minority patients had indigent health coverage. Statistical analysis further revealed that age, marital status, indigent enrollment, D'Amico risk, and the option of cryoablation may influence patient's selection for surgical management of localized prostate cancer.
Many factors influence treatment selection including race, age, marital status, enrollment in an indigent program, and a high D'Amico risk. The less invasive nature of cryoablation appeared to influence patients' opinion regarding surgery for the treatment of localized prostate cancer, especially in African American men.
我们的安全网医院提供微创、传统开放和经会阴根治性前列腺切除术，以及在适当情况下的放射治疗和医学肿瘤学服务。从历史上看，由于不明原因，只有少数非裔美国人和西班牙裔患者选择手术治疗。有趣的是，2003年丹佛健康医疗中心（DHMC）启动前列腺冷冻消融项目（全腺）后，我们注意到在这些特定患者群体中，冷冻疗法用于治疗局限性前列腺癌的趋势。我们分析了接受局限性前列腺癌评估的少数族裔男性的特征，并评估了局限性前列腺癌治疗决策中的相关因素。
对2003年1月至2012年1月在我们安全网医院就诊的524例前列腺癌患者进行回顾性研究。记录患者在肿瘤会诊后选择的治疗方法。获取健康保险状况、人口统计学数据以及所选治疗方法的个人原因陈述。然后形成影响治疗决策相关因素的多因素逻辑回归分析。患者根据达米科风险分层标准进行分类。
保险状况显示，只有1%的非裔美国患者拥有私人健康保险，而西班牙裔患者为5%，白人为26%。非裔美国男性的达米科风险较高，转移评估结果更呈阳性，但他们接受手术的可能性较小，反而常选择放射治疗。相反，西班牙裔和白人男性通常选择冷冻消融和根治性前列腺切除术进行治疗。手术转诊主要是有私人健康保险的白人男性。大多数少数族裔患者拥有贫困医疗保险。统计分析进一步表明，年龄、婚姻状况、贫困参保、达米科风险以及冷冻消融选项可能会影响患者对局限性前列腺癌手术治疗的选择。
许多因素会影响治疗选择，包括种族、年龄、婚姻状况、参加贫困项目以及达米科高风险。冷冻消融侵入性较小的特点似乎影响了患者对局限性前列腺癌手术治疗 的看法，尤其是在非裔美国男性中。
