UICC World Cancer Congress 2006

Objective: To describe racial differences in the evaluation of men with newly diagnosed prostate cancer. Methods: We conducted a prospective cohort analysis of black (n=10,710) and white (n=97,070) men with incident prostate cancer between 1998 and 2002 using Surveillance, Epidemiology and End Results (SEER)-Medicare linked datafiles. The primary outcomes were use of bone scan, spine x-ray, MRI Pelvis, CT Pelvis, and cystoscopy in the 6 months after prostate cancer diagnosis. Statistical analysis included descriptive summaries and logistic regression to adjust for age, clinical stage, comorbidity, and socioeconomic status. Results: Approximately two-thirds of the cohort underwent a bone scan. Overall bone scan rates did not differ between black and white men, but blacks with metastatic disease were significantly less likely to have had a bone scan (p=0.0001). Rates of spine x-rays were higher among black men, irrespective of stage. Approximately half the cohort underwent pelvic MRI or CT. Black men were less likely to have had a pelvic MRI (p=0.0001) but more likely to have had a pelvic CT (p=0.0001). Conclusions: A majority of men newly diagnosed with prostate cancer undergo bone scan and pelvic imaging. The pattern of test use differs between blacks and whites, with use of different modalities for pelvic and bone imaging and higher rates of cystoscopy among blacks. These differences are unlikely to be fully explained by racial differences in clinical presentation. We are currently investigating whether these differences are explained by characteristics of the hospitals and providers utilized and whether these differences are associated with differences in outcomes.