Comparison of Efficacy and Frequency of Screening and Selected Treatment Modalities for Prostate Cancer in African American and White Men PDF Download
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Languages : en
Pages : 107
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Prostate cancer mortality among African-American is twice than for whites. The aim of the present research concept development proposal was to determine the feasibility of conducting a study to evaluate differences in prostate cancer screening and treatment practices between African-American and White men. A case-control study where New Jersey residents dying of prostate cancer between the ages of 55 and 79 years during the period July 1, 1997 through June 30, 2000 are being enrolled as cases. Controls are a representative group of New Jersey male residents ascertained from HCFA files, matched to the cases on age and race. Till December 15, 1999, 198 cases and 126 controls have been recruited into the study. The majority of patients were Whites (85.9% of cases and 86.5% of controls) and the response rate was 70%. The frequency of PSA screening among cases was 15.9% as compared to 38.9% among controls. Only 12 patients with localized prostate cancer were recruited into the study and four (33.3%) of them had prostatectomy. Because of small numbers, we were unable to assess screening and treatment differences by race. In conclusion, although the number of patients recruited were too small for valid conclusion, we have demonstrated the feasibility of conducting a case-control study to evaluate racial differences in the frequency of screening and early treatment for prostate cancer. Based on the pilot data, a grant proposal for a major study is under preparation.
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Category :
Languages : en
Pages : 107
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Book Description
Prostate cancer mortality among African-American is twice than for whites. The aim of the present research concept development proposal was to determine the feasibility of conducting a study to evaluate differences in prostate cancer screening and treatment practices between African-American and White men. A case-control study where New Jersey residents dying of prostate cancer between the ages of 55 and 79 years during the period July 1, 1997 through June 30, 2000 are being enrolled as cases. Controls are a representative group of New Jersey male residents ascertained from HCFA files, matched to the cases on age and race. Till December 15, 1999, 198 cases and 126 controls have been recruited into the study. The majority of patients were Whites (85.9% of cases and 86.5% of controls) and the response rate was 70%. The frequency of PSA screening among cases was 15.9% as compared to 38.9% among controls. Only 12 patients with localized prostate cancer were recruited into the study and four (33.3%) of them had prostatectomy. Because of small numbers, we were unable to assess screening and treatment differences by race. In conclusion, although the number of patients recruited were too small for valid conclusion, we have demonstrated the feasibility of conducting a case-control study to evaluate racial differences in the frequency of screening and early treatment for prostate cancer. Based on the pilot data, a grant proposal for a major study is under preparation.
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Languages : en
Pages : 7
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The purpose of this project was to conduct a pilot study that would generate supporting information regarding medical record documentation of genito-urinary symptoms for a population-based case-control study of PSA screening for prostate cancer in African Americans. The lack of symptoms documented in the patient's medical record was to be used as evidence that PSA was intended as a screening examination. The database of patients screened with PSA at UNC Hospitals was reviewed and we began a preparatory analysis of available patients. We identified the number of patients to be abstracted and generated a report detailing patient name, date of test, test value, and the patient's medical record number through the collaboration of UNC Hospitals and the UNG School of Medicine Office of Information Services. We had numerous consultations with a biostatistician regarding appropriate statistical techniques to compare blinded coding of PSA test (diagnostic vs. screening) with the intentions of the ordering physician. Although UNG's Institutional Review Board approved the pilot study on January 11, 1999 after acknowledging the minimal risk associated with the project, we were unable to execute the pilot due to the six month time constraint and lack of approval from the Army's Human Subjects Research Review Board. In the future, we do plan to conduct the study and use the results as support for a case- control screening proposal with the collaborative efforts of Dr. Noel Weiss.
Author: Kevin M. McKay
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Category :
Languages : en
Pages : 77
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Purpose: Prostate cancer (PCA) is one of the most prevalent male cancers nationally, and prostate cancer incidence and mortality rates are higher in Mississippi than the national average for all racial groups. There is currently no "gold standard" treatment modality for early stage (T1-T2) prostate cancer primarily due to a lack of research comparing the various treatment modalities in a systematic manner over an extended time frame. As such, there is an array of viable treatment options that include, but are not limited to: prostatectomy via surgical excision; radiation therapy via brachytherapy; or external beam radiation therapy delivered by a linear accelerator. These three broad treatment modality types have been subdivided and become more specialized with the introduction of technological advancements. Current research suggests that these treatment modalities have similar outcomes in terms of efficacy for early stage (T1-T2) prostate cancer, with the main differences being the possibility of adverse side effects that vary by treatment modality type. While there has been some research regarding early stage (T1-T2) prostate cancer treatment modality utilization in other states, there is currently a dearth of information regarding prostate cancer treatment modalities in Mississippi. This research provides a needed analysis of early stage (T1-T2) prostate cancer treatments in Mississippi by examining the utilization of treatment modalities and demographic data including race, geographic location, and insurance status. This analysis could help explain variations in prostate cancer treatments and outcomes for African Americans and Caucasians, as well as rural versus urban residents. This information could also be a valuable resource for state entities, individual and corporate health care providers, and individual patients and their families. Methods: This research includes: (1) an analysis of the Mississippi Cancer Registry data set to provide a framework for this research to be as comprehensive and innovative as possible in regard to the variables under examination; (2) the correlation of patient demographic data to treatment modalities; and (3) an analysis of data from 2007 until 2011. The data set from the Mississippi Cancer Registry contained 9,382 patient records. Pertinent demographic data included race, age at diagnosis, date of diagnosis, date of treatment, date of death, stage and grade, county of residence, insurance status, and treatment modality. The Mississippi State Department of Rural Health list of rural counties was used to differentiate between rural and urban counties in order to identify potential areas of reduced access to health care within the state. Pearson's Chi-square test was used to study if treatment modality utilization differs by patients' demographics and their insurance status; binary logistic regression and multinomial logistic regression were conducted to investigate factors associated with treatment modality utilization. Results: Analysis of the Mississippi Cancer Registry data set showed that there was a statistically significant difference in treatment modality utilization with regard to race,. geographic location, and insurance status. Conclusion: The statistical analysis indicated that a patient's geographic location within Mississippi, as well as their race and insurance status, had a statistically significant difference in the treatment modality utilized for the treatment of early stage (T1-T2) prostate cancer. This research could provide a valuable resource that would allow for more concrete planning with regards to improving health care access for patients with early stage (T1-T2) PCA, equipment purchasing decisions for treatment providers, coverage decisions for insurance providers, and individual patients with PCA having more information available to them and their family members to make informed decisions.
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Languages : en
Pages : 59
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The goal of this project was to better understand the psychosocial and cultural factors affecting prostate cancer screening among African American (AA) and White men. It was a community-based participatory research project, which involved participation of local community members through a community steering committee. The first phase of the project was a focus group study, and then the focus group results were used to develop a questionnaire instrument. We conducted the Nashville Men's Preventive Health Survey, drawing a stratified and clustered random sample of 392 men ages 40 to 70. White men were more likely than AA men in recommended age ranges to have ever had a DRE or PSA, and to report having a PSA in the past 12 months, but there was no racial difference in DRE screening in the past year. Informed decision-making (IDM) was lower than actual screening rates, with only 2 out of 5 men who engaged in IDM by talking with their doctors about PC and screening options, with no difference by race. The number of visits to the doctor was positively associated with IDM, in particular for AA men. Having a medical home was positively associated with PC screening, but the effect was stronger for White men. For AA men, age, previous visit with a urologist, and doctor recommendation were positively associated with PC screening.
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Languages : en
Pages : 7
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Prostate cancer (PCa) incidence and mortality is higher among African American (AA) men compared to all other groups. There is compelling evidence that higher mortality is due to the greater likelihood of AA men to be diagnosed with advanced-stage PCa. PCa screening specifically prostate-specific antigen test (PSA) and digital rectal exam (DRE), has been shown to increase early-stage diagnoses. Although several organizations recommend annual PCa screening starting at age 45 for AA men, screening among AA men is low. Indeed, interventions to increase screening and the early detection of PCa among AA men are critical. Although culturally targeted health interventions have been found to be effective there are no interventions that have systematically addressed culturally relevant factors in PCa screening among AA men. The primary aim of the proposed study is to develop and evaluate the impact of a culturally targeted (CT) print intervention on PCa screening participation among AA 410 men through a randomized controlled trial. The proposed research also seeks to investigate the mediational pathways (i.e., mechanisms) through which the culturally targeted print intervention impacts screening participation.
Author: Rita Wortman
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Category : African American men
Languages : en
Pages : 88
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The purpose of this study was to explore factors affecting incidence of prostate cancer screening tests in African American men. Prostate cancer is the second leading cause of cancer deaths among African American men, who die from the disease at more than twice the rate of white men. Orem's Self-Care Deficit Model guided the research. When detected early and monitored closely, prostate cancer may not differ for men of different ethnic backgrounds. The real problem may be in the lack of screening and delayed treatment in African American men. A purposive sample of 56 African American men was assessed using the Prostate Cancer Screening Knowledge instrument (PCSK), and correlations were sought between PCSK results and the three demographics of age, marital status, and education. The comparison found no statistically significant differences in PCSK results based on marital status and education. But the comparison did show higher PCSK scores among the men aged fifty and above, at a statistically significant level, suggesting that age is a determining factor in how much the men know and how much they would do regarding screenings.
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Category :
Languages : en
Pages : 30
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Author: Angelo Dewitt Moore
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Category :
Languages : en
Pages : 72
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Author: R. David McNally
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Languages : en
Pages :
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Prostate cancer is the most commonly diagnosed cancer among men in the United States. It is frequently cited that racial disparities in mortality between Caucasian and African American men with localized prostate cancer exist. In addition, the question of whether prostate cancer screening with the prostate specific antigen blood test (PSA) leads to reduced mortality remains unanswered. Outcomes theory and survival analysis have shown controversial inconsistencies in support of early detection methods for prostate cancer to the extent that experts in the medical community do not agree on best-practice guidelines suggestive of eliminating such disparities and reducing mortality. The purpose of this study was to explore the relationship between screening PSA tests and racial differences in mortality among Caucasian and African American men with application of a propensity scoring analysis on a large population-based data set. Prostate cancer patients diagnosed from January 1, 1986 through December 31, 2006 (n = 515,802 cases) from the SEER-17 data set linked to Medicare claims files were included. A separate analysis using a 5% randomized group of over 263,000 men without prostate cancer was also examined. The results demonstrated that no statistically significant differences in mortality between Caucasians and African Americans in the prostate cancer group existed (p=0.993). Further, the same result was found among men from the 5% randomized group without prostate cancer (p= 0.832), that no statistically significant difference exists for this study population when using a propensity scoring analysis and a conditional Cox regression model. From both analyses, no survival benefit was found for screened men versus non-screened men when using the PSA test for early detection. In addition, because age is a well-known predictor of death, a separate analysis was performed on age-matched men. The results for the age analysis also demonstrated no statistically significant differences in racial mortality or whether screening PSA reduced mortality after applying a propensity scoring analysis to a conditional Cox regression model. In conclusion, it is believed that using a propensity scoring method and Cox regression analysis improved the evaluation of this large population data set where censoring for survival time was important and where matched pairs were utilized. Further work in health services research using large population-based data sets should be pursued and incorporating Cox regression with a propensity analysis can be helpful.
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Category :
Languages : en
Pages : 44
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