Open Access

ARTICLE

Ethnic minorities (African American and Hispanic) males prefer prostate cryoablation as aggressive treatment of localized prostate cancer

Fernando J. Kim^1,2, Priya N. Werahera³, David E. Sehrt¹, Diedra Gustafson¹, Rodrigo D. Silva¹, Wilson R. Molina¹

1 Division of Urology, Denver Health Medical Center, Denver, Colorado, USA
2 University of Colorado Cancer Center Denver, University of Colorado Denver, Denver, Colorado, USA
3 Department of Pathology and Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
Address correspondence to Dr. Fernando Kim, Urological Department, Denver Health Hospital, 777 Bannock St. MC0206, Denver, CO 80204 USA

Canadian Journal of Urology 2014, 21(3), 7305-7311.

Abstract

Introduction: Our safety net hospital offers minimally invasive, traditional open and perineal radical prostatectomies, as well as radiation therapy and medical oncological services when appropriate. Historically, only few African American and Hispanic patients elected surgical procedures due to unknown reasons. Interestingly, after initiation of the prostate cryoablation program (Whole Gland) in 2003 at Denver Health Medical Center (DHMC) we noticed a trend towards cryotherapy in these specific patient populations for the treatment of localized prostate cancer. We analyzed the profile of ethnic minority men evaluated for localized prostate cancer and evaluated the associated factors in the decision making for the treatment of localized prostate cancer.
Materials and methods: A retrospective review of 524 patients seen for prostate cancer from January 2003 to January 2012 in our safety net hospital was conducted. The treatment selected by the patient after oncologic consultation was then recorded. The health insurance status, demographic data, and personal statements of reasons for elected procedure were obtained. A multivariate logistic regression for associated factors influencing treatment decisions was then formed. Patients were categorized by using the D’Amico risk stratification criteria.
Results: The insurance status revealed that only 1% of African American patients had private health insurance versus 5% Hispanic and 26% of Caucasians. African American men were at higher D’Amico risk with more positive metastasis evaluation yet were less likely to undergo surgery and instead often elected for radiation therapy. Conversely, Hispanic and Caucasian men often elected cryoablation and radical prostatectomy for their treatment. Referrals for surgery were primarily Caucasian males with private health insurance. Most minority patients had indigent health coverage. Statistical analysis further revealed that age, marital status, indigent enrollment, D’Amico risk, and the option of cryoablation may influence patient’s selection for surgical management of localized prostate cancer.
Conclusion: Many factors influence treatment selection including race, age, marital status, enrollment in an indigent program, and a high D’Amico risk. The less invasive nature of cryoablation appeared to influence patients’ opinion regarding surgery for the treatment of localized prostate cancer, especially in African American men.

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