Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer

Objective: African-American (AA) men have excess mortality from prostate cancer compared with White men, which has remained unchanged over several decades. The purpose of this study is to determine if race/ethnicity is an independent predictor of receipt of any definitive treatment vs. watchful waiting/active surveillance (WW/AS). Methods and materials: Men diagnosed with prostate cancer from 2004 to 2011 were identified from the Surveillance, Epidemiology, and End-Results program. Multinomial logistic regression analysis was performed to determine the relative risk ratio (RRR) of receipt of radical prostatectomy (RP), external beam radiation therapy (RT), brachytherapy, cryotherapy, or combination therapy vs. WW/AS. Results: Compared with White men, AA men were significantly less likely to receive RP (RRR = 0.53, P < 0.001), brachytherapy (RRR = 0.72, P < 0.001), cryotherapy (RRR = 0.84, P = 0.001), and combination therapy (RRR = 0.70, P < 0.001), and more likely to receive RT (RRR = 1.03, P = 0.041) vs. AS/WW. Hispanic men were significantly less likely to receive RP (RRR = 0.84, P < 0.001) and brachytherapy (RRR = 0.77, P < 0.001), and more likely to receive RT (RRR = 1.08, P < 0.001), and cryotherapy (RRR = 1.19, P = 0.005) vs. AS/WW compared with White men. Conclusions: The disparate risk of receiving definitive treatment among AA and Hispanic men represents a significant public health issue that requires efforts to improve physician education, increase cultural competency, and ensure equitable access. (C) 2016 Elsevier Inc. All rights reserved.