Radical prostatectomy: lower rates among African-American men

This study compares radical prostatectomy rates by race among male Medicare patients in New York. A retrospective analysis was conducted of all radical prostatectomies performed on hospitalized male Medicare beneficiaries for the period 1991 through 1993. Basic trend data also were analyzed for 1990. Pattern analysis was conducted on the 4154 procedures performed between 1990 and 1993. The rate of radical prostatectomy rose dramatically during the 3-year period from 1990 to 1992 among New York's 1.1 million male Medicare beneficiaries. The rates rose for both African Americans and whites. However, the annual rates of radical prostatectomy for African Americans were significantly below those for whites. Lower rates of radical prostatectomies were observed for African Americans in all age groups except the < 65-year-old group. However, the total number of radical prostatectomies in this age group were small in number. An important finding was the lower annual rates of radical prostatectomy for African Americans in the 65- to 69-year-old age group. During the period under study, prostate cancer among Medicare patients in New York rose by 33.8% for African Americans and 26.5% for whites. Significantly, local disease was found at the time of diagnosis in 70% of whites but in only 55% of African Americans. These data reflect later stage at diagnosis among African-American males. These results indicate that despite higher national rates for prostate cancer, male African-American Medicare patients in New York have reduced access to radical prostatectomy as a treatment modality. This is especially of importance in the < 70-year-old group in whom most authorities consider the procedure appropriate. The reasons for this reduced access are discussed as are the measures needed to remedy the underlying inequities in health care.