Nonaggressive management of white and Black prostate cancer patients in the United States

Appropriate treatment for prostate cancer is controversial because of the lack of information from randomized clinical trials indicating the benefits of one treatment over another. Watchful waiting or conservative management remains an alternative for this disease. This paper assesses the extent to which White and Black prostate cancer patients in the USA choose nonaggressive therapy. Non-aggressive therapy is defined as patients not receiving cancer-directed surgery or radiation, or that undergo a transurethral resection of the prostate (TURP)/simple prostatectomy but no radiation. Of 112,445 prostate cancer patients diagnosed in 1992-1996, 40% Whites and 46% Blacks were not aggressively treated. Approximately 28% Whites and 33% Blacks did not receive cancer-directed surgery or radiation, and 12% Whites and 13% Blacks underwent a TURP/simple prostatectomy but no radiation. Stage, histologic grade and age at diagnosis, race (White and Black), and number of cancer primaries each significantly influence how patients are managed. Black patients are more likely than White patients to forego aggressive therapy, even after adjusting for less preferential stage and histologic grade at diagnosis, as well as differences in age and number of cancer primaries. Explanations for this result deserve further consideration.