Black versus white racial differences in clinical stage at diagnosis and treatment of prostatic cancer in connecticut

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Abstract
There are few published data on stage-specific prostate cancer incidence rates in United States black patients versus white patients, and there are no data comparing treatment received by black versus white patients with prostate cancer. Using data from a population-based cancer registry, the proportion of prostate cancers diagnosed in Connecticut from 1985-1988 at each clinical stage was examined for blacks and whites, along with stage-specific incidence rates. First course of treatment was also examined by clinical stage. The proportion of cases diagnosed at the metastatic stage was higher for black patients (35.4%) than for white patients (22.1%), and age-specific incidence rates for metastatic cancer were 1.5-3.3 times higher for black patients. Among localized-stage cases, the distribution of histologic grade (or degree of differentiation) did not differ in blacks versus whites, suggesting no difference in tumor aggressiveness or potential response to treatment. For localized (or A and B)-stage cancers, significantly lower use of prostatectomy in blacks versus whites younger than 70 years of age was the only important black-white difference, which requires confirmation in other studies. Frequency of use of hormonal therapy including endocrine surgery (orchiectomy) did not differ between black and white patients with pelvic metastases or disseminated disease. Comparisons were also made with data on treatment (all races combined) reported from the American College of Surgeons' national survey of prostate cancer cases diagnosed in 1983. Earlier detection of prostate cancer in blacks is needed to reduce black-white differences in stage at diagnosis and thereby reduce overall differences in survival rates. There was little evidence for inequities in treatment of prostate cancer for black patients versus white patients in Connecticut.