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

Explaining racial differences in prostate cancer in the United States: sociology or biology?

Black men in the United States have the highest incidence and mortality from prostate cancer in the world. Even after adjusting for stage at diagnosis, black men have higher mortality rates than white men. Multiple reasons have been postulated to explain these findings including access to care, attitudes about care, socioeconomic and education differences, differences in type and aggressiveness of treatment, dietary, and genetic differences. While each reason may contribute to the higher incidence or higher mortality, likely combinations of reasons will best explain all the findings. Racial differences in socioeconomic status have been well established and we review the significance of these findings in relationship to prostate cancer. Also, with recent advances in the understanding of genetic variation in the human genome, in general, and in the genes involved in pathways relevant to prostate cancer biology, in particular, a number of genes with alleles which differ in frequency between black and white men have been proposed as a genetic cause or contributor to the increased prostate cancer risk in black men. However, the clinical significance of these genetic differences is not fully known. Finally, we conclude with some thoughts as to how to integrate the findings from sociological as well as biological studies and touch upon methods to reduce the disparate burden of prostate cancer among blacks in the United States.

Demographics and health-related factors of men receiving prostate-specific antigen screening in Utah

BACKGROUND

Identifying who is pursuing prostate-specific antigen (PSA) screening for prostate cancer is prerequisite to effectively influencing participation in PSA screening and educating people about potential screening implications and personal risk. This paper describes the relationship between select demographic and health-related factors with PSA screening.

METHODS

Analysis was based on 1,293 men age 40 years or older who responded to a cross-sectional random telephone survey involving 12 health districts in the state of Utah from June 1 to August 31, 1996. Independent variables were current age, race, marital status, education, household income, medical insurance, level of physical activity, intake of fruits and vegetables, receipt of psychiatric help, religious preference, church attendance, general health status, and employment.

RESULTS

Forty-eight percent of respondents reported having had a PSA in the past year. PSA screening in the previous year significantly increased and leveled off with age: 23.9% for ages 40-49, 51.4% for ages 50-59, 67.4% for ages 60-69, and 67.0% for ages 70+. After adjusting for age, only marital status and medical insurance were significantly related to PSA screening, with medical insurance having the largest effect. Approximately 50.6% married men and 33.5% unmarried men had a PSA in the past year. Percentages for insured and uninsured men were 49.4 and 16.6%, respectively.

CONCLUSION

A substantial portion of elderly men, particularly those who are married and medically insured, have had a PSA test in the past year. This information makes it possible to more effectively influence participation in PSA screening and educate people about potential screening implications and personal risk.