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Cultural and social factors influence prostate cancer treatment


Researchers say social and cultural factors play a significant role in patients' prostate cancer treatment decisions. A new study published in the May 1, 2005 issue of CANCER (, a peer-reviewed journal of the American Cancer Society, finds non-medical variables, such as marital status, high school education, and race/ethnicity may play a larger role in patients' treatment decisions than previously believed.

Prostate cancer is now detected earlier than ever because of the introduction of a simple blood test in 1987 called the Prostate Specific Antigen (PSA) test. 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). Moreover, the treatments can lead to serious side effects, including urinary incontinence, impotence, and bowel urgency.

It is widely assumed that men make treatment decisions based on medical considerations, such as age, other existing conditions, and the grade of the tumor. Investigators led by Thomas Denberg, M.D., Ph.D. of the University of Colorado at Denver and Health Sciences Center 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 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 authors summarize, "This study confirmed the hypothesis that sociocultural factors add significant explanatory power to traditional biomedical variables in understanding treatment patterns of early-stage prostate cancer."


Article: "Marriage and Ethnicity Predict Treatment in Localized Prostate Carcinoma," Thomas D. Denberg, Brenda L. Beaty, Fernando J. Kim, John F. Steiner, CANCER; Published Online: March 28, 2005 (DOI: 10.1002/cncr.20982); Print Issue Date: May 1, 2005.

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