Klabunde C N, Potosky A L, Harlan L C, Kramer B S
Applied Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.
Med Care. 1998 Sep;36(9):1337-48. doi: 10.1097/00005650-199809000-00006.
Controversy and uncertainty surround use of radical prostatectomy, radiation therapy, and conservative symptomatic management in treating elderly men with nonmetastatic prostate cancer. Prior studies have demonstrated variations in use of these therapies by patient age, race, and geographic region. This study examined trends in treatment for nonmetastatic prostate cancer in black and white men aged 65 and older during the period 1986 to 1993. The study also explored factors related to use of initial therapies in these men.
A cohort of 52,915 men (48,410 white; 4,505 black) obtained from the linked SEER-Medicare dataset was used in an observational design. Various sociodemographic and clinical measures were incorporated in the analysis.
For both races, use of aggressive therapy had increased with time, although this trend appears to be slowing. Black men were less likely to undergo radical prostatectomy than were white men, but use of radiation therapy did not differ markedly by race. High socioeconomic status and a lack of comorbid conditions were among the factors predictive of aggressive therapy receipt. The relation between race and receipt of aggressive therapy was dependent on whether prostate cancer was detected by transurethral resection of the prostate. Sociodemographic and clinical characteristics explained approximately half the difference between black men and white men in radical prostatectomy use.
This study documents racial differences and changing practice patterns in the treatment of nonmetastatic prostate cancer in elderly men. Further research is required to more fully understand reasons for racial differences, as well as to promote rational use of health care resources.
对于老年非转移性前列腺癌患者，根治性前列腺切除术、放射治疗以及保守对症治疗的使用存在争议和不确定性。既往研究表明，这些治疗方法的使用因患者年龄、种族和地理区域而异。本研究调查了1986年至1993年期间65岁及以上黑人和白人男性非转移性前列腺癌的治疗趋势。该研究还探讨了这些男性使用初始治疗方法的相关因素。
从SEER - 医疗保险关联数据集中选取了52915名男性（48410名白人；4505名黑人）组成队列，采用观察性设计。分析中纳入了各种社会人口统计学和临床指标。
对于两个种族，积极治疗的使用随时间增加，尽管这一趋势似乎在放缓。黑人男性接受根治性前列腺切除术的可能性低于白人男性，但放射治疗的使用在种族上没有显著差异。高社会经济地位和无合并症是预测接受积极治疗的因素。种族与接受积极治疗之间的关系取决于前列腺癌是否通过经尿道前列腺切除术检测到。社会人口统计学和临床特征解释了黑人男性和白人男性在根治性前列腺切除术使用上约一半的差异。
本研究记录了老年男性非转移性前列腺癌治疗中的种族差异和不断变化的实践模式。需要进一步研究以更全面地理解种族差异的原因，并促进医疗资源的合理使用。
