RACIAL DIFFERENCES IN PROSTATE CANCER TREATMENT OUTCOMES--YOUNG MEN

前列腺癌给黑人男性带来了巨大的死亡率和发病率负担，比起白人男性，特别是在美国东南部，前列腺癌的负担更大。黑人男性的前列腺癌诊断较晚，因此预后较差。这项研究将建立在我们之前对老年黑人男性前列腺癌的研究基础上，并使用与我们对直肠癌的研究类似的方法。我们的具体问题(控制潜在的混杂因素)是：1)黑人男性接受的局部前列腺癌治疗是否不如白人男性积极？2)患有前列腺癌的黑人男性和患有前列腺癌的白人男性的筛查频率是否较低？3)关于前列腺癌筛查和治疗的知识、态度和信念是否与患有前列腺癌的黑人和白人男性不同？我们将对北卡罗来纳州一个33县地区的300例黑人男性癌症事件和300例65岁及以上白人男性前列腺癌事件进行个案研究。病例将从北卡罗来纳州中央癌症登记中心确定。在获得患者医生的许可后，我们将获取医疗记录并进行详细的电话访问，以评估人口统计数据；收入和贫困水平；教育；社会支持水平；对筛查测试的态度，特别是癌症筛查；获得医疗保健的机会；使用前列腺癌和其他筛查测试的历史与使用PSA作为诊断测试的比较；癌症的阶段和使用的治疗类型。这项研究将确定：1)最初的治疗是否可以解释治疗结果中的种族差异，2)对筛查测试的总体态度，特别是前列腺癌，或其他因素是否似乎解释了这些差异。对种族可作为指标的多种可能因素的检查将极大地提高我们对前列腺癌中种族差异的理解，从而导致有针对性的干预。

Prostate cancer poses significant burdens of mortality and morbidity on black men, greater than in while men, especially in the southeastern US. Prostate cancer in black men is diagnosed at a later state, with consequently a worse prognosis. This study will build on our previous studies on prostate cancer in elderly black men, and use similar methods to our study of rectal carcinoma. Our specific questions (controlling for potential confounders) are: 1) Do black men receive less aggressive treatment for localized prostate cancer than white men? 2) Do black men with prostate cancer have a history of less frequent screening with prostate specific antigen (PSA) and white men with prostate cancer? 3) Are knowledge, attitudes and beliefs regarding PSA screening and treatment different black and white men with prostate cancer? We will conduct a case-case study of 300 incident cancer among black men and 300 incident cases of prostate cancer among white men age 65 and older in a 33 county area of North Carolina. Cases will be identified from the North Carolina Central Cancer Registry. After obtaining permission from the patient's physician, we will obtain medical records and conduct a detailed telephone interview to assess demographics; income and poverty levels; education; level of social support; attitudes toward screening tests, especially cancer screening; access to health care; history of use of prostate and other screening tests compared with use of PSA as a diagnostic test; stage of cancer and types of treatments used. This study will determine: 1) whether initial treatment could account for these racial disparities in treatment outcomes, and 2) whether attitudes toward screening tests in general, and prostate cancer in particular, or other factors appear to explain these differences. This examination of the multiple possible factors for which race may serve as an indicator will substantially improve our understanding of racial disparities in prostate cancer, leading to targeted interventions.