Race/ethnicity, literacy, and prostate cancer: Initial findings from the COMPARE registry.

4620 Background: Comprehensive Multicenter Prostate Adenocarcinoma Registry (COMPARE) evaluates variations in initial prostate cancer (PCa) therapy according to race/ethnicity. Similar studies for prostate cancer patients with PSA failure following radiation therapy or radical prostatectomy are unreported. Poor health literacy and African American race are predictive of advanced stage prostate cancers at diagnosis. METHODS: COMPARE includes 778 men (62% >70 yr; 80% white and 13% AA) with rising PSA post-localized PCa therapy. Median follow-up post-registry entry is 5 months. Enrollment at 146 sites to date: urology (N = 129), radiation oncology (n = 12), other (n = 5). Most sites are private practice (n = 132) vs academic (n = 14). Health literacy was tested with a 7-item validated word recognition test; scores of ≥4 correlate with ≥6(th) grade literacy. Variations in therapy, both initial and after PSA failure, were assessed as a function of patient/regional factors. RESULTS: Initial therapy included radical prostatectomy (RP) 44.5%, external beam radiation therapy (EBRT) 30.7%, brachytherapy (BT) 13.1%, other (11.5%). Literacy data are available for 725 men, one fifth had poor literacy skills (<4); higher rates of low literacy were present in AA vs white men (p < 0.05). Significant variations in initial care were associated with poor vs normal literacy skills (brachytherapy: 8% vs 16%; radical prostatectomy: 52% vs 44%, p < 0.05). Watchful waiting was the most common management for PSA failure patients, 82% for men aged ≤70 yr and 77% for men >70 yr. Among prostate cancer patients >70 yr, after adjustment for literacy and Gleason score, African American men were only 41% as likely as whites to undergo watchful waiting (95% CI, 19% to 92%). CONCLUSIONS: Poor health literacy is common among men with prostate cancer; these men are more likely to receive radical prostatectomy. With men >70 yr with PSA failure post-radical prostatectomy or post-radiation therapy, African American men were 2.5× more likely than white men to choose therapy (primarily castration) over watchful waiting. Findings from smaller cohorts found that urologic symptoms were the most important factor associated with use of castration versus watchful waiting for PSA failure. No significant financial relationships to disclose.

Duke Scholars

Author Susan Halabi Biostatistics & Bioinformatics, Division of Biostatistics