Low socioeconomic status reduces cancer-specific survival after prostatectomy
MedWire News: Men with low-risk prostate cancer are twice as likely to die from the disease after being treated with radical prostatectomy if they are of low rather than high socioeconomic status (SES), report US researchers.
Having a low SES also renders low-risk patients less likely to receive definitive focal therapy than patients with a high SES, says the research team in the journal Urology.
"These findings point to the need for improvement in prostate cancer screening and treatment for men of lower SES," suggest Nicholas Hellenthal and colleagues from the University of California Davis Medical Center in Sacramento.
The team investigated whether socioeconomic factors may be at the root of the acknowledged disparity in prostate cancer incidence and survival among different races and ethnicities.
Using data for 81,665 low-risk (Gleason score ≤7) prostate cancer patients registered in the California Cancer Registry, Hellenthal et al identified 39,234 men treated with radical prostatectomy and 42,431 treated with radiotherapy, and stratified them by race, age, and year of treatment.
The cohort was also divided into quintiles based on SES, taking into account median household income, education level, proportion below 200% poverty level, and median house value.
After a median follow-up of 53 months, 0.2% of the prostatectomy group and 0.5% of the radiotherapy group had died of prostate cancer.
The researchers calculated that men in the lowest SES group (n=14,072) were two times more likely to die of prostate cancer after prostatectomy than their counterparts in the highest SES group (n=36,082).
After adjustment for race (including White, African-American, Hispanic, Asian-Pacific Islander, or other), the association was strengthened, giving low SES men a 2.2-fold increase in risk for prostate cancer-specific death compared with high SES men.
The same trend was noted among radiotherapy patients who were 2.24 times more likely to die from prostate cancer if they were in the lowest SES quintile compared with the highest, with comparable results after adjustment for race (hazard ratio 2.21).
Overall, men in the lowest SES group were approximately 40% less likely to undergo prostatectomy and 30% less likely to undergo radiotherapy compared with men in the highest SES group, for each breakdown in year of diagnosis, age, and race.
"The disparity in treatment may be a result of patient-driven factors, such as work-related or financial stressors, and poor access to centers that offer prostatectomy," note Hellenthal and co-workers.
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By Sarah Guy