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Patient-Reported Outcomes Mostly Similar Between Racial Groups After Prostatectomy

November 25, 2016

By Rita Buckley

NEW YORK (Reuters Health) - A new study found no clinically significant racial variation after radical prostatectomy (RP) in several patient-reported outcomes, including bother scores and sexual function.

But African American men reported a greater drop in urinary continence than did white men, researchers report in European Urology, online November 3.

"Racial disparities in prostate cancer survival are well described," lead author Dr. Mark Tyson from Vanderbilt University Medical Center in Nashville, Tennessee, told Reuters Health by email. "However, variations in the effects of treatment on patient-reported urinary, sexual, bowel, and hormone function by race/ethnicity are not."

Dr. Tyson and colleagues conducted a prospective, population-based, observational study in more than 3,700 men diagnosed with localized prostate cancer in 2011-2012.

The study, named CEASAR for Comparative Effectiveness Analysis of Surgery and Radiation, measured patient-reported function and bother with the 26-item Expanded Prostate Index Composite (EPIC, scale of 0-100, with higher scores indicating better function) at baseline and at six and 12 months after enrollment.

Eligible men were aged no more than 80 years old with clinical stage cT1 or cT2 disease, prostate-specific antigen <50 mg/dl, and diagnosis within six months of enrollment.

Race/ethnicity was classified as non-Hispanic white, non-Hispanic African-American, and Hispanic according to patient-reported data, or if missing, SEER registry data.

All race/ethnic groups reported considerable declines in scores for urinary incontinence after RP compared with active surveillance. African-American men reported a greater difference than did white men (adjusted difference-in-differences, 8.4 points; p=0.01), but there was no significant difference in the change in EPIC bother scores between the groups.

In addition, "No clinically significant racial variation was noted for the sexual, bowel, irritative voiding, or hormone domains," Dr. Tyson and colleagues write.

"The interaction between treatment and race/ethnicity was modest overall," Dr. Tyson told Reuters Health, adding that race/ethnicity was not nearly as predictive of post-treatment function at one year as treatment selection and baseline function.

According to Dr. Tyson, this is very positive news for minority communities.

"The study demonstrated that among different races and ethnicities, there were no significant differences between outcomes," said Dr. R. Jeffrey J. Karnes, a urology consultant at the Mayo Clinic in Rochester, Minnesota, who was not involved in the research.

He told Reuters Health by phone that it's good to know there are no racial or ethnic disparities in the outcomes of radical prostatectomies. "It's important to ensure that all patients receive equal care," he said. "This is what we strive for."

Limitations included unmeasured confounding, such as differential clinician experience, access to high-quality care, or pelvic floor rehabilitation - factors that may give rise to biased effect estimates, Dr. Karnes said.

According to Dr. Tyson, these were addressed with a comprehensive set of patient-level variables combined with advanced model building to minimize the effects of confounding.

"We also performed a sensitivity analysis using propensity-score adjustments, and noted no substantial differences in model outputs," he said.

He said that the CEASAR study data are uniquely equipped to investigate joint associations between treatment effects and socioeconomic determinants of health outcomes.

"They will eventually lay the groundwork for web-based patient-facing decision support tools," he said.


Eur Urol 2016.

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