Treatment of localized prostate cancer in African-American compared with Caucasian men. Less use of aggressive therapy for comparable disease.

The objective of this study is to evaluate differences in treatment for localized prostate cancer in African-American compared with Caucasian men. A cohort of patients was identified from the 1988-1989 Surveillance, Epidemiology, and End Results data base. Data were linked by county of residence to the Area Resource File. The main outcome measures were (1) the receipt of aggressive therapy (radical prostatectomy or external beam radiation) and (2) the treatment modality (radical prostatectomy or external beam radiation). Of 5,786 subjects, 15% were treated with a radical prostatectomy, 29% received external beam radiation, and 56% did not receive aggressive therapy. African Americans were less likely (relative risk 0.46; 95% confidence interval 0.39, 0.54) than Caucasians to receive aggressive therapy. Among those receiving aggressive therapy, African Americans were less likely (relative risk 0.64; 95% confidence interval 0.48, 0.86) than Caucasians to have a radical prostatectomy. Adjustment for patient, disease, and community health care availability characteristics did not change these results. We conclude that African-American and Caucasian men receive different treatments for localized prostate cancer. The reasons for the differences, and their ultimate effect on mortality and quality of life require further study.