Skip to main content

Advertisement

SpringerLink
Log in

Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

INTRODUCTION: Several recent studies have noted that African Americans disproportionately receive “watchful waiting” for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996.

METHODS: Race/ethnicity, comorbidity, stage, grade, age, and expected lifespan and their association with the receipt of watchful waiting were examined in multivariate logistic regression analyses. Race-stratified logistic regression analyses were also used to examine racial/ethnic variation in the association of clinical and demographic factors with the receipt of watchful waiting among African-American, Hispanic, and non-Hispanic white men.

RESULTS: African-American (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3 to 1.6) and Hispanic men (OR, 1.3; 95% CI, 1.1 to 1.5) were significantly more likely than non-Hispanic white men to receive watchful waiting in a multivariate model adjusted for age, comorbidity, stage, grade, and life expectancy. Advanced stage and grade, lower life expectancy, older age, and high comorbidity indices were also significantly associated with an increase in the odds of receipt of watchful waiting in multivariate analyses. In general, the association between the receipt of watchful waiting and the clinical characteristics (i.e., stage, grade, and age) were similar for the three racial/ethnic groups. In race-stratified logistic regression analyses, life expectancy was associated with an increase in the odds of receiving watchful waiting but results were statistically significant for whites only. There was also a statistically significant increase in the odds of receiving watchful waiting for African-American and white men with high comorbidity indices but not Hispanic men. The odds of receiving watchful waiting were also higher for African-American and Hispanic men who resided in census tracts where a large percentage of residents had not completed high school than for white men who resided in similar census tracts.

CONCLUSION: The disproportionate receipt of watchful waiting among African Americans and Hispanics is not completely explained by racial/ethnic variation in clinical characteristics or life expectancy as measured in this study. These data suggest that there are other factors that contribute to racial/ethnic differences in receipt of watchful waiting that warrant investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Cancer Society. Cancer Facts and Figures 2001. Atlanta, Ga: American Cancer Society; 2001.

    Google Scholar 

  2. American Cancer Society. Cancer Facts and Figures for African Americans. Atlanta, Ga: American Cancer Society; 2001.

    Google Scholar 

  3. Ries LAG, Eisner MP, Kosary CL, et al., eds. SEER Cancer Statistics Review 1973–99, National Cancer Institute. Bethesda, Md: http://seer.cancer.gov/csr/1973–1999/2002.

  4. Hoffman RM, Gilliland J, Eley W, et al. Racial and ethnic differences in advanced stage prostate cancer: the Prostate Cancer Outcomes Study. J Natl Cancer Inst. 2001;93:388–95.

    Article  PubMed  CAS  Google Scholar 

  5. Harlan LC, Potosky A, Gilliland FD, et al. Factors associated with initial therapy for clinically localized prostate cancer: Prostate Cancer Outcomes Study. J Natl Cancer Inst.; 2001;93:1864–71.

    Article  PubMed  CAS  Google Scholar 

  6. Klabunde C, Potosky AL, Harlan LC, Kramer BS. Trends and black/white differences in treatment for nonmetastatic prostate cancer. Med Care. 1998;36:1337–48.

    Article  PubMed  CAS  Google Scholar 

  7. Desch CE, Penberthy L, Newschaffer CJ, et al. Factors that determine the treatment of local and regional prostate cancer. Med Care. 1996;34:152–62.

    Article  PubMed  CAS  Google Scholar 

  8. Jones GW, Mettlin C, Murphy GP, et al. Patterns of care for carcinoma of the prostate gland. Results of a national survey of 1984 and 1990. J Am Coll Surg. 1995;180:545–54.

    PubMed  CAS  Google Scholar 

  9. Fowler JE, Bigler SA, Bowman G, Kilambi NR. Race and cause-specific survival with prostate cancer: influence of clinical stage, Gleason score, age and treatment. J Urol. 2000;163:137–42.

    Article  PubMed  Google Scholar 

  10. Gilliland FD, Hunt WX, Key CR. Ethnic variation in prostate cancer survival in New Mexico. Cancer Epidemiol Biomarkers Prev. 1996;5:247–51.

    PubMed  CAS  Google Scholar 

  11. Robbins AS, Whittemore AS, Thom DH. Differences in socioeconomic status and survival among white and black men with prostate cancer. Am J Epidemiol. 2000;1511:409–16.

    Google Scholar 

  12. Morris CR, Snipes KP, Schlag R, Wright WE. Sociodemographic factors associated with prostatectomy utilization and concordance with the physician data query for prostate cancer (United States). Cancer Causes Control. 1999;10:503–11.

    Article  PubMed  CAS  Google Scholar 

  13. Mettlin CJ, Murphy GP, Cunningham MP, Menck HR. The National Cancer Data Base Report on race, age, and region variations in prostate cancer treatment. Cancer. 1997;80:1261–6.

    Article  PubMed  CAS  Google Scholar 

  14. Shavers VL, Brown ML. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. 2002;94:334–57.

    PubMed  Google Scholar 

  15. National Cancer Institute. Prostate Cancer (PDQ®) Treatment-Health Professionals. http://cancernet.nci.nih.gov.cgi. Last accessed: December 6, 2002.

  16. National Comprehensive Cancer Network. The Complete Library of Practice Guidelines in Oncology. Rockledge, Pa: Rockledge; 2001.

    Google Scholar 

  17. Krahn MD, Bremner KE, Asaria J, et al. The ten-year rule revisited: accuracy of clinicians’ estimates of life expectancy in patients with localized prostate cancer. Urology. 2002;60:258–63.

    Article  PubMed  Google Scholar 

  18. Perron L, Moore L, Bairati I, Bernard P, Meyer F. PSA screening and prostate cancer mortality. Can Med Assoc J. 2002;166:586–91.

    Google Scholar 

  19. Jacobsen SJ, Katusic SK, Bergstralh EJ, et al. Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing. JAMA. 1995;274:1445–9.

    Article  PubMed  CAS  Google Scholar 

  20. Epstein JI, Walsh PC, Carmichael M, Brendler CB. Pathologic clinical findings predict tumor extent nonpalpable (stage T1C) prostate cancer. JAMA. 1994;271:368–74.

    Article  PubMed  CAS  Google Scholar 

  21. Etzioni R, Penson DF, Legler JM, et al. Overdiagnosis due to prostate specific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst. 2002;94:981–90.

    PubMed  Google Scholar 

  22. Vollmer RT, Egawa S, Kuwao S, Baba S. The dynamics of prostate specific antigen during watchful waiting of prostate cancer. Cancer. 2002;94:1692–8.

    Article  PubMed  Google Scholar 

  23. Teloken C. Management of erectile dysfunction secondary to treatment for localized prostate cancer. Cancer Control. 2001;6:540–5.

    Google Scholar 

  24. Grise P, Thurman S. Urinary incontinence following treatment of localized prostate cancer. Cancer Control. 2001;6:532–9.

    Google Scholar 

  25. Stephenson RA. Prostate cancer trends in the era of prostate-specific antigen. An update of incidence, mortality, and clinical factors from the SEER database. Urol Clin North Am. 2002;29:173–81.

    Article  PubMed  Google Scholar 

  26. Wilt TJ. Clarifying uncertainty regarding detection and treatment of early-stage prostate cancer. Semin Urol Oncol. 2002;20:10–7.

    Article  PubMed  Google Scholar 

  27. Potosky AL, Legler J, Albertsen PC, et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the prostate cancer outcomes study. J Natl Cancer Inst. 2000;92:1582–92.

    Article  PubMed  CAS  Google Scholar 

  28. Yao S, Yao G. Understanding and appreciating overdiagnosis in the PSA era. J Natl Cancer Inst. 2002;94:958–9.

    PubMed  Google Scholar 

  29. Tannock IF. Eradication of a disease: how we cured symptomless prostate cancer. Lancet. 2002;359:1341–2.

    Article  PubMed  Google Scholar 

  30. Vis AN. Does PSA screening reduce prostate cancer mortality? Can Med Assoc J. 2002;166:586–7.

    Google Scholar 

  31. Neal DE, Donovan JL. Prostate cancer: to screen or not to screen? Lancet Oncol. 2000;1:17–24.

    Article  PubMed  CAS  Google Scholar 

  32. Bunting PS. Screening for prostate cancer with prostate-specific antigen: beware the biases. Clin Chimica Acta. 2002;315:71–97.

    Article  CAS  Google Scholar 

  33. Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare Data. Med Care. 2002;40 (suppl):IV-3–IV-18.

    Google Scholar 

  34. Fritz A, Ries L. The SEER Program Code Manual, 3rd edn. Cancer Statistics Branch, Surveillance Program, Division of Cancer Control and Population Sciences National Cancer Institute, January 1, 1998.

  35. Anderson RN. Unites States Life Tables 1998 National Vital Statistics Reports. Vol. 48. No 18. Hyattsville, Md: National Center for Health Statistics; 2001.

    Google Scholar 

  36. Klabunde CN, Potosky AL, Legler JM, Warren J. Development of a co-morbidity measure using physician claims data. J Clin Epidemiol. 2000;53:1258–67.

    Article  PubMed  CAS  Google Scholar 

  37. SAS Institute Inc. SAS Version 9.0. Cary, NC.

  38. The North-West Uro-Oncology Group. A Preliminary Report on a Patient-Preference Study to Compare Treatment Options in Early Prostate Cancer. Stockport, UK: BJU International; 2002;90:253–6.

    Google Scholar 

  39. Moul JW, Swsterhenn IA, Connelly RR, et al. Prostate-specific antigen values at the time of prostate cancer diagnosis in African American men. JAMA. 1995;274:1277–81.

    Article  PubMed  CAS  Google Scholar 

  40. Chapple A, Siebland S, Herxheimer A, McPherson HA, Shepperd S, Miller R. Is ‘watchful waiting’ a real choice for men with prostate cancer? A qualitative study. BJU Int. 2002;90:257–64.

    Article  PubMed  CAS  Google Scholar 

  41. Diefenbach MA, Dorsey J, Uzzo RG, et al. Decision-making strategies for patients with localized prostate cancer. Semin Urol Oncol. 2002;20:55–62.

    Article  PubMed  Google Scholar 

  42. Demark-Wahnefried W, Schildkraut JM, Iselin CE, et al. Treatment options, selection, and satisfaction among African American and white men with prostate carcinoma in North Carolina. Cancer. 1998;83:320–30.

    Article  PubMed  CAS  Google Scholar 

  43. Holmberg L, Bill-Axelson A, Helgesen F, et al. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer. N Engl J Med. 2002;347:781–89.

    Article  PubMed  Google Scholar 

  44. McIntyre IG, Clarke RB, Anderson E, Clarke NW, George NJ. Molecular prediction of progression in patients with conservatively managed prostate cancer. Urology. 2001;58:762–6.

    Article  PubMed  CAS  Google Scholar 

  45. Lee MM, Chang JS, Jacobs B, Wrensch MR. Complementary and alternative medicine use among men with prostate cancer in 4 ethnic populations. Am J Public Health. 2002;92:1606–9.

    Article  PubMed  Google Scholar 

  46. Zietman A, Moughghan J, Owen J, Hanks G. The patterns of care survey of radiation therapy in localized prostate cancer: similarities between the practice nationally and in minority-rich areas. Int J Radiation Oncol Biol Phys. 2001;50:75–80.

    Article  CAS  Google Scholar 

  47. Lai S, Lai H, Lamm S, Obek C, Krongrad A, Roos B. Radiation therapy in non-surgically-treated nonmetastatic prostate cancer: geographic and demographic variation. Urology. 2001;57:510–7.

    Article  PubMed  CAS  Google Scholar 

  48. Cooper GS, Virnig B, Klabunde CN, Schussler N, Freeman J, Warren JL. Use of SEER-Medicare data for measuring cancer surgery. Med Care. 2002;40:IV43-IV47.

    Article  Google Scholar 

  49. Virnig BA, Warren JL, Cooper GS, Klabunde CN, Schussler N, Freeman J. Studying radiation therapy using SEER-Medicare-Linked Data. Med Care. 2002;40(suppl):IV-49–IV-54.

    Google Scholar 

  50. Warren J, Harlan LC, Fahey A, et al. Utility of the SEER-Medicare data to identify chemotherapy use. Med Care. 2002;40(suppl):IV-55–IV-61.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. the Department of Surgery/DoD Center for Prostate Disease Research/Uniformed Services University and Walter Reed Army Medical Center, Bethesda, Md.

    Judd W. Moul MD

  2. Information Management Systems, Bethesda, Md.

    Angela Fahey BS

  3. Division of Cancer Control and Population Sciences, Applied Research Program/HSEB, National Cancer Institute, 6130 Executive Blvd. EPN 4005 MSC 7344, 20892-7344, Bethesda, MD

    Vickie L. Shavers PhD, Martin L. Brown PhD, Arnold L. Potosky PhD, Carrie N. Klabunde PhD & W. W. Davis PhD

Authors
  1. Vickie L. Shavers PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin L. Brown PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arnold L. Potosky PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carrie N. Klabunde PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. W. Davis PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Judd W. Moul MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Angela Fahey BS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vickie L. Shavers PhD.

Additional information

The opinions and assertions are the views of the authors and are not to be construed as reflective of the views of the National Cancer Institute or the U.S. Army Department of Defense.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shavers, V.L., Brown, M.L., Potosky, A.L. et al. Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer. J GEN INTERN MED 19, 146–155 (2004). https://doi.org/10.1111/j.1525-1497.2004.30209.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30209.x

Key words

Search

Navigation