Treatment of early-stage prostate cancer among rural and urban patients

Authors

  • Laura-Mae Baldwin MD, MPH,

    Corresponding author
    1. WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington, Seattle, Washington
    • Corresponding author: Laura-Mae Baldwin, MD, MPH, University of Washington, Department of Family Medicine, Box 354982, Seattle, WA 98195-4982; Fax: (206) 616-4768; lmb@uw.edu.

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  • C. Holly A. Andrilla MS,

    1. WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington, Seattle, Washington
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  • Michael P. Porter MD, MS,

    1. Department of Urology, University of Washington, and the VA Puget Sound Health Care System, Seattle, Washington
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  • Roger A. Rosenblatt MD, MPH, MFR,

    1. WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington, Seattle, Washington
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  • Shilpen Patel MD,

    1. Department of Radiation Oncology, University of Washington, Seattle, Washington
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  • Mark P. Doescher MD, MSPH

    1. Peggy and Charles Stephenson Cancer Center and Department of Family Medicine, University of Oklahoma Health Services Center, Oklahoma City, Oklahoma
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Abstract

BACKGROUND

Geographic barriers and limited availability of cancer specialists may influence early prostate cancer treatment options for rural men. This study compares receipt of different early prostate cancer treatments between rural and urban patients.

METHODS

Using 2004-2006 SEER Limited-Use Data, 51,982 early prostate cancer patients were identified (T1c, T2a, T2b, T2c, T2NOS; no metastases) who were most likely to benefit from definitive treatment (< 75 years old, Gleason score < 8, PSA ≤ 20). Definitive treatment included radical prostatectomy, daily external beam radiation for 5 to 8 weeks, brachytherapy, or combination external beam radiation/brachytherapy. Adjusted definitive treatment rates were calculated by rural–urban residence overall, and for different sociodemographic and cancer characteristics, and different states based on logistic regression analyses, using general estimating equation methods to account for clustering by county.

RESULTS

Adjusted definitive treatment rates were lower for rural (83.7%) than urban (87.1%) patients with early-stage prostate cancer (P ≤ .01). Rural men were more likely than urban men to receive nondefinitive surgical treatment and no initial treatment. The lowest definitive treatment rates were among rural subgroups: 70 to 74 years (73.9%), African Americans (75.6%), American Indians/Alaska Natives (77.8%), single/separated/divorced (76.8%), living in New Mexico (69.3%), and living in counties with persistent poverty (79.6%).

CONCLUSIONS

Between 2004 and 2006, this adjusted analysis found that men who were living in rural areas were less likely to receive definitive treatment for their early-stage prostate cancer than those living in urban areas. Certain rural patient groups with prostate cancer need particular attention to ensure their access to appropriate treatment. Rural providerss, rural health care systems, and cancer advocacy and support organizations should ensure resources are in place so that the most vulnerable rural groups (men between 60 and 74 years of age; African American men; men who are single, separated, or divorced; and men living in rural New Mexico) can make informed prostate cancer treatment choices based on their preferences. Cancer 2013;119:3067—3075. © 2013 American Cancer Society.

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