The effect of race and rural residence on prostate cancer treatment choice among men in Georgia

Objective: To analyze differences for prostate cancer by race and in rural areas.

Methods: We studied 516 men younger than 75 years old with incident prostate cancer during 2005-08 in 33 counties in Southwest Georgia (SWGA), a rural area of 700,000 (40% African American). Treatment data were abstracted from medical records, and interviews conducted with 314 men. We also compared treatments in SWGA vs. Atlanta in 2005.

Results: External radiation plus brachytherapy was the most common treatment in SWGA (31%), followed by external radiation alone (27%), and surgery (18%). Patients in SWGA had higher odds of external radiation vs. surgery than men in Atlanta (OR 2.66, 95% CI 1.85-3.81). African Americans had higher odds of choosing treatment other than surgery, compared with whites (OR 2.04, 95% CI 1.57-2.63), more so in SWGA (OR 3.51, 95% CI 1.92-6.41) than Atlanta (OR 1.76, 95% CI 1.32-2.35) (P = .05). Poor communication with their physician was reported by 13% of men in SWGA, more among African Americans than whites (OR 3.95, 95% CI 1.52-10.30), and more among those who had no treatment vs. some treatment (OR 5.77, 95% CI 1.88-11.46).

Conclusions: In both rural and urban Georgia, white men with prostate cancer had surgery more frequently than African Americans, although data suggest this may be caused more by income differences than race. Rural patients as opposed to urban patients were more likely to receive external radiation and less likely to receive brachytherapy alone or surgery. Poor communication with a physician, particularly prevalent among African Americans, was associated with choosing no treatment in SWGA.