DOD Prostate: Income Not Race Cited as Reason for Prostate Mortality Excess in Minorities

ATLANTA, Sept. 11 -- Income status appears to play a greater role than race in explaining why some men are less likely to undergo surgery for prostate cancer and may explain why mortality is higher among minorities.

"Race is not predictive when you correct for all other factors and adjust for health insurance status," James Mohler, M.D., of the Roswell Park Cancer Institute in Buffalo, New York, told attendees at the Department of Defense Prostate Cancer Research Program meeting.

Noting that prostate cancer mortality among African-American men is twice that of Caucasian men, Dr. Mohler said that he and his colleagues focused on frequency of radical prostatectomy because the surgical procedure appears to provide a mortality benefit when compared to other treatments or observation.

Jane Schroeder, M.P.H, D.V.M., an epidemiologist at the University of North Carolina in Chapel Hill, said that among the 85 men in the preliminary analysis who did not have health insurance of any kind, 71 were under the age of 65.

"One of the things we are going to continue to explore in this study is whether out-of-pocket expenses for treatment influences the decision to opt for radical prostatectomy or to accept 'watchful waiting' or other treatments," she said.

Dr. Schroeder noted that even among men who have health insurance, co-pays involved in surgery may cause them to select other treatments.

Dr. Schroeder reported results based on 896 men recruited from northeastern North Carolina and 503 men from southeastern Louisiana. Radical prostatectomy was performed in 783 of the men, and other treatments were utilized by 516; 100 men were undecided as to which treatment they were going to opt to undergo.

Schroeder analyzed her findings using an income cutoff of 200% of poverty level. About 70% of men whose family income was twice the poverty level opted to undergo radical prostatectomy.

Of the 410 men who had income less than 200% of the poverty level, just 190 - or 46% - had radical prostatectomy.

"Even when we adjusted for race, state of residence, health literacy, age, co-morbidities, cancer grade and insurance, the difference was still about 16% difference in decision to undergo surgery (P