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Mortality Rates Differ Widely, Prostate Cancer Study Finds

African-American Men Hit Hard by the Second Leading Cause of Cancer Death Among U.S. Males

by Kathleen Scalise, Public Affairs
posted October 7, 1998

Compared to other men, African American males stand a much greater chance of dying from prostate cancer even when they are diagnosed at similar stages of the disease and have access to the same care, according to Berkeley researchers. Their conclusions are reported this week in the journal Cancer.

The study of men who died after being diagnosed with prostate cancer found that about half are killed directly by the disease. In the remainder of cases, death was attributed to other causes such as coronary heart disease or other cancers. Prostate cancer is the second leading cause of cancer death among men in the U.S.

For African American men, "prostate cancer is twice as likely as for white men and they are much more likely to be diagnosed with advanced stages of the disease," said Public Health Professor William Satariano, principal investigator on the project.

Even after adjusting for the patients' age and stage of disease at diagnosis, the likelihood of "dying of prostate carcinoma was 68 percent greater for black men than white men," Satariano said. His co-authors are research specialist Kathleen Ragland of Berkeley's School of Public Health and Stephen Van Den Eeden of the Oakland Kaiser Permanente Division of Research.

Why African American men appear more vulnerable to the disease is not known and needs further study, said Satariano. Explanations could include different treatment choices despite having the same health plan and access to care, or a physical difference in reaction to the disease, the treatment, or other accompanying health conditions.

Other groups from the sample population that proved more likely to ultimately die of prostate cancer included those who were younger than 65, those diagnosed with more advanced stages of the disease, those treated with hormone therapy or those who lived longer than six months after diagnosis.

The Berkeley study looked at more than 500 Kaiser Permanente patients who were diagnosed with the disease between 1980 and 1984 and subsequently died, whether from prostate cancer or other causes.

Prostate cancer is most often found in older men. The incidence of the disease rises rapidly after age 50 and the median age at diagnosis is 72. Given their age, many prostate cancer patients also have other chronic health problems.

The new study attempted to separate the relationship between death by prostate cancer as opposed to other diseases.

Satariano is concerned that mortality rates for prostate cancer, already high, may still be grossly underestimated.

"They are based solely on situations in which prostate cancer alone is listed as the underlying cause of death," he said. "It's hard to say that only one condition caused the death, so mortality rates for prostate cancer could be underestimated by as much as one half."

Also, "our results seem to suggest that prostate cancer may aggravate the course of other health problems," he said.

"This study suggests we need to understand more about the cancer's occurrence. What does it really mean to say someone has prostate cancer and heart disease? It may be that the prostate cancer aggravates the course of the heart disease. When you attempt to examine the health of older people, multiple diseases is a complication," he said.

How such statistics are kept can influence health care decisions. Older men sometimes disregard aggressive or even any medical treatment for prostate cancer, believing that the disease, which is often slow moving, is unlikely to cause serious health problems in their remaining years.

This may be a mistake, according to the new study, especially for African American men. Whatever the age of the patient, the study reveals that "the wise course is to at the very least monitor the course of the disease," Satariano said. "Especially for African American men, we're really just scratching the surface of understanding this."


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