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Racial/Ethnic Differences in Functional Outcomes in the 5 Years After Diagnosis of Localized Prostate Cancer

From the Departments of Preventive Medicine and Urology, University of Southern California Keck School of Medicine, Los Angeles, CA; Medicine Service, New Mexico Veterans Administration Health Care System; Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Surgery (Urology), University of Connecticut Health Center, Farmington, CT

Address reprint requests to Ann S. Hamilton, PhD, University of Southern California Keck School of Medicine, Dept of Preventive Medicine, 1441 Eastlake Ave, Rm 3427A, MC9175, Los Angeles, CA 90089-9175; e-mail: ahamilt{at}usc.edu

PURPOSE: We investigated racial/ethnic differences in functional outcomes up to 5 years after diagnosis among men with aggressively treated localized prostate cancer.

PATIENTS AND METHODS: Patients were from the Prostate Cancer Outcomes Study, a population-based cohort study that surveyed patients at 6, 12, 24, and 60 months after diagnosis. Analyses were stratified by primary treatment. Racial/ethnic differences at each time point were assessed using Generalized Estimating Equations, adjusting for pretreatment function, age at diagnosis, secondary treatment, and other confounders. An adjusted summary score for each functional domain was calculated for each time period.

RESULTS: Patients included 1,475 non-Hispanic white, 321 African-American, and 279 Hispanic prostate cancer patients. After 60 months, among prostatectomy patients, African-Americans had significantly higher sexual function scores than non-Hispanic whites (43.9 v 36.1; P = .02), but were more likely to have a moderate to big problem with sexual function (50.6% v 44.4%; P = .04). African-Americans also had higher urinary function scores at 5 years than non-Hispanic whites (78.5 v 72.4; P = .04) and were less likely to have problems with incontinence. Changes in sexual and bowel function after radiotherapy showed no significant racial/ethnic differences.

CONCLUSION: This long-term cohort study found that, among prostatectomy patients, African-Americans had better recovery of sexual and urinary function at 60 months after diagnosis that was likely to be of mild clinical significance, despite reporting more problems with sexual function than non-Hispanic whites. More study is necessary to understand reasons for these differences. In contrast, no racial/ethnic differences in recovery from radiotherapy were found.

This study was supported by the following contracts from the National Cancer Institute, National Institutes of Health, Bethesda, MD, to each of the participating institutions: grant Nos. NO1-PC-67007, NO1-PC67009, NO1-PC-67010, NO1-PC-67006, NO1-PC-67005, NO1-PC-67005, and NO1-PC-67000.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.