Social and cultural factors play a significant role in the treatment decisions of patients with prostate cancer

Mar 28 2005

A new study has found that social and cultural factors play a significant role in the treatment decisions of patients with prostate cancer.

Marital status, high school education, and race/ethnicity may play a far greater role in patients' treatment decisions than previously believed.

The study to be published in the May 1, 2005 issue of CANCER, by Thomas Denberg, M.D., Ph.D. of the University of Colorado at Denver and Health Sciences Centre in Denver, reviewed data from 27,920 Hispanic, non-Hispanic, white, and black men without underlying conditions who were registered in the Surveillance, Epidemiology, and End Results (SEER) cancer database.

The introduction of a simple blood test in 1987, the Prostate Specific Antigen (PSA) test, now means Prostate cancer is detected earlier than ever. However, the treatment options for prostate cancer – radical prostatectomy, external beam radiation, and brachytherapy – have no evidence of clear mortality benefit over expectant treatment (i.e., observation), and the treatments can lead to serious side effects, including urinary incontinence, impotence, and bowel urgency.

It has always been assumed that men make treatment decisions based on medical considerations, such as age, other existing conditions, and the grade of the tumour, but the investigators found that sociocultural and racial factors independently predicted treatment.

Caucasian, black, and Hispanic patients were equally likely to receive curative treatments over "watchful waiting" but while Caucasian and Hispanic men were more likely to choose prostatectomy, black men were more likely to be treated with radiation. Independently, marriage was also an important predictor of treatment: married men in all three groups were much more likely than unmarried men to receive curative treatment over watchful waiting, and they were also more likely than their unmarried counterparts to receive prostatectomy compared with radiation.

The study, says the authors, confirms the hypothesis that sociocultural factors add significant explanatory power to traditional biomedical variables in understanding treatment patterns of early-stage prostate cancer.