Prostate cancer in Asian Americans: incidence, management and outcomes in an equal access healthcare system.

ABSTRACT

UNLABELLED Study Type--Therapy (outcomes research) Level of Evidence 2c. What's known on the subject? and What does the study add? While epidemiological studies have shown a significantly lower incidence of adenocarcinoma of the prostate in Asia than the United States, several studies have demonstrated that Asian Americans present with more advanced stages, higher tumour grades, and worse mortality-incidence ratios than Caucasian Americans. This study, conducted in an equal access military healthcare system, reveals improved pathological and survival outcomes in Asian Americans compared to other races. This may indicate that worsened outcomes previously reported among Asian Americans diagnosed with adenocarcinoma of the prostate may be related to access to care, language barriers, socioeconomic status, or cultural factors. OBJECTIVE: • To characterize the incidence, management and clinicopathological characteristics of prostate cancer (CaP) in a population of Asian Americans undergoing mandatory annual screening in an equal access healthcare system. PATIENTS AND METHODS: • Men registered into the military-based Center for Prostate Disease Research multi-institutional database from 1989-2007 with biopsy-proven CaP and categorized as Asian American, Caucasian or African American were included. • Demographic information, treatment modality, clinicopathological characteristics and outcomes were compared. RESULTS: • In total, there were 10,964 patients; 583 (5.3%) were Asian Americans. Asian Americans had lower clinical stage (P < 0.001) but worse biopsy grade (P < 0.001) than other groups. They were more likely to choose radical prostatectomy (RP) (P < 0.001) and showed a higher percentage of organ-confined disease (P < 0.001). • Asian Americans had improved biochemical recurrence free (P < 0.01) and overall survival (P < 0.001) rates compared to African Americans or Caucasians treated with RP or external radiation therapy. CONCLUSIONS: • Asian Americans with CaP treated in an equal access healthcare system have improved pathological outcomes and survival characteristics compared to other races. • Asian ethnicity's negative impact on survival noted by others appears to be the result of factors other than the tumour's intrinsic behaviour, such as language barriers, socioeconomic status and cultural norms.