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`Peer Reviewed
`
`Title:
`Who is the average patient presenting with prostate cancer?
`Journal Issue:
`Urology, 66(5 SUPPL.)
`Author:
`Greene, KL
`Cowan, JE
`Cooperberg, MR
`Meng, MV
`DuChane, J
`Carroll, PR
`Publication Date:
`11-01-2005
`Series:
`UC San Francisco Previously Published Works
`Permalink:
`http://escholarship.org/uc/item/11k4j6r7
`DOI:
`https://doi.org/10.1016/j.urology.2005.06.082
`Local Identifier:
`375786
`Abstract:
`Prostate cancer screening, diagnosis, and treatment have changed dramatically in the last 20
`years. Patients with newly diagnosed prostate cancer have many treatment options available. We
`attempted to determine how patient demographics and quality of life (QOL) have changed, and we
`describe the average patient with newly diagnosed prostate cancer in the early 21st century. From
`the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) we identified 3003
`men with prostate cancer diagnosed between 1997 and 2003 for whom pretreatment demographic
`
`eScholarship provides open access, scholarly publishing
`services to the University of California and delivers a dynamic
`research platform to scholars worldwide.
`
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`
`

`
`and QOL data were available. All patients completed both the University of California-Los Angeles
`Prostate Cancer Index (UCLA-PCI) and the Rand Medical Outcomes Study 36-Item Short-Form
`Health Survey (SF-36) as self-administered questionnaires at the time of diagnosis. We compared
`demographic variables (age at diagnosis, race/ethnicity, education, number of comorbidities,
`body mass index [BMI], and insurance type), treatment choice, and pretreatment QOL scores
`on the SF-36 and UCLA-PCI scales for the periods 1997 to 1999 or 2000 to 2003. Stratified
`analysis by risk category was performed for demographic and QOL data for the 2 periods.
`Race/ethnicity and insurance demographics were statistically different for the 2 periods. Low-
`risk patients also showed a statistically increased BMI in the 2000 to 2003 period. Risk category
`predicted performance on both inventories, with low-risk patients having better function than
`intermediate-risk patients and high-risk patients in the areas of urinary bother, bowel function and
`bother, and sexual function and bother, as well as in many general well-being and emotional health
`scales on the SF-36. We conclude that the "average" prostate cancer patient is white, 65 years of
`age, overweight, educated at a college level, and has 1 to 2 comorbidities. Patients report average
`or above-average pretreatment health-related QOL for all scales based on 2 validated instruments.
`In this cohort, more patients chose radical prostatectomy than any other form of treatment. © 2005
`Elsevier Inc. All rights reserved.
`Copyright Information:
`All rights reserved unless otherwise indicated. Contact the author or original publisher for any
`necessary permissions. eScholarship is not the copyright owner for deposited works. Learn more
`at http://www.escholarship.org/help_copyright.html#reuse
`
`eScholarship provides open access, scholarly publishing
`services to the University of California and delivers a dynamic
`research platform to scholars worldwide.
`
`

`
`WHO IS THE AVERAGE PATIENT PRESENTING WITH
`PROSTATE CANCER?
`
`KIRSTEN L. GREENE, JANET E. COWAN, MATTHEW R. COOPERBERG, MAXWELL V. MENG,
`JANEEN DUCHANE, AND PETER R. CARROLL, FOR THE CANCER OF THE PROSTATE STRATEGIC
`UROLOGIC RESEARCH ENDEAVOR (CaPSURE) INVESTIGATORS
`
`ABSTRACT
`Prostate cancer screening, diagnosis, and treatment have changed dramatically in the last 20 years. Patients
`with newly diagnosed prostate cancer have many treatment options available. We attempted to determine
`how patient demographics and quality of life (QOL) have changed, and we describe the average patient with
`newly diagnosed prostate cancer in the early 21st century. From the Cancer of the Prostate Strategic
`Urologic Research Endeavor (CaPSURE) we identified 3003 men with prostate cancer diagnosed between
`1997 and 2003 for whom pretreatment demographic and QOL data were available. All patients completed
`both the University of California–Los Angeles Prostate Cancer Index (UCLA-PCI) and the Rand Medical
`Outcomes Study 36-Item Short-Form Health Survey (SF-36) as self-administered questionnaires at the time
`of diagnosis. We compared demographic variables (age at diagnosis, race/ethnicity, education, number of
`comorbidities, body mass index [BMI], and insurance type), treatment choice, and pretreatment QOL scores
`on the SF-36 and UCLA-PCI scales for the periods 1997 to 1999 or 2000 to 2003. Stratified analysis by risk
`category was performed for demographic and QOL data for the 2 periods. Race/ethnicity and insurance
`demographics were statistically different for the 2 periods. Low-risk patients also showed a statistically
`increased BMI in the 2000 to 2003 period. Risk category predicted performance on both inventories, with
`low-risk patients having better function than intermediate-risk patients and high-risk patients in the areas of
`urinary bother, bowel function and bother, and sexual function and bother, as well as in many general
`well-being and emotional health scales on the SF-36. We conclude that the “average” prostate cancer
`patient is white, 65 years of age, overweight, educated at a college level, and has 1 to 2 comorbidities.
`Patients report average or above-average pretreatment health-related QOL for all scales based on 2
`validated instruments. In this cohort, more patients chose radical prostatectomy than any other form of
`treatment. UROLOGY 66 (Suppl 5A): 76–82, 2005. © 2005 Elsevier Inc.
`
`CaPSURE is supported by TAP Pharmaceutical Products, Inc.
`(Lake Forest, IL). Partial funding to Dr. Carroll, Dr. Greene, J.
`Cowan, Dr. Meng, Dr. Cooperberg, Dr. DuChane, and the
`CaPSURE Investigators was also provided by TAP Pharmaceuti-
`cal Products, Inc. This research was additionally funded by Na-
`tional Institutes of Health/National Cancer Institute University of
`California-San Francisco SPORE (Specialized Program of Re-
`search Excellence) Grant No. P50 C89520.
`From the Department of Urology, Program in Urologic Oncol-
`ogy, Urologic Outcomes Research Group, UCSF/Mt. Zion Com-
`prehensive Cancer Center, University of California–San Fran-
`cisco, San Francisco, California, USA (KLG, JEC, MRC, MVM,
`PRC); and TAP Pharmaceutical Products, Inc., Lake Forest, Illi-
`nois, USA (JD).
`Reprint requests: Peter R. Carroll, MD, Department of Urol-
`ogy, University of California–San Francisco, 1600 Divisadero,
`Box 1695, San Francisco, California 94143-1695. E-mail:
`pcarroll@urol.ucsf.edu
`
`Prostate cancer is the most common noncutane-
`
`ous malignancy in men, with an anticipated
`232,090 new cases predicted for 2005 in the United
`States. With the advent of widespread prostate-
`specific antigen (PSA) screening, disease incidence
`has increased in the last 10 years.1 Despite this
`increase in incidence, however, rates of death due
`to prostate cancer have declined, and there has
`been a corresponding stage migration resulting in
`the diagnosis of men at lower risk and at an earlier
`clinical stage.2 Because early-stage prostate cancer
`may follow a prolonged and indolent clinical
`course for up to 15 years after diagnosis, newly
`diagnosed patients are living with prostate cancer,
`as well as the effects of treatment, for longer peri-
`ods with attendant implications for health-related
`quality of life (HRQOL).3,4 As a result, pretreat-
`
`© 2005 ELSEVIER INC.
`76 ALL RIGHTS RESERVED
`
`0090-4295/05/$30.00
`doi:10.1016/j.urology.2005.06.082
`
`

`
`ment quality of life (QOL) and ongoing HRQOL
`measurements for patients with prostate cancer are
`of increasing importance as patients are faced with
`treatment options that may affect physical, sexual,
`and emotional health and well-being.5,6 Although
`much of the literature has focused on treatment
`choices and outcomes for men with newly diag-
`nosed prostate cancer, we sought to describe the
`HRQOL, demographic, and socioeconomic status
`of men already diagnosed with prostate cancer and
`to determine how these factors have changed over
`time.
`
`METHODS
`
`The Cancer of the Prostate Strategic Urologic Research En-
`deavor (CaPSURE) is a longitudinal, observational disease
`registry of men with biopsy-proven adenocarcinoma of the
`prostate. The CaPSURE database contains demographic, clin-
`ical, treatment, and outcomes data for ⬎11,000 patients from
`40 urology practices across the United States (34 community
`based, 3 Veterans’ Administration, and 3 academic practices).
`Patients are enrolled in CaPSURE regardless of age, stage of
`disease, or intended treatment plan. They are treated accord-
`ing to the usual practices of their physicians, and are followed
`until they die or withdraw from the study. Additional details of
`the CaPSURE database methodology have been previously re-
`ported.7
`We identified 3003 men from the CaPSURE database who
`were diagnosed between 1997 and 2003 with prostate cancer
`and had available pretreatment demographic and QOL data.
`All patients with newly diagnosed prostate cancer were in-
`cluded regardless of stage or type of treatment.
`QOL data were compiled from self-administered question-
`naires including the University of California–Los Angeles
`Prostate Cancer Index (UCLA-PCI) and the Rand Medical
`Outcomes
`Study 36-Item Short-Form Health Survey
`(SF-36).8,9 The UCLA-PCI is a widely validated scale that mea-
`sures 6 domains of prostate cancer–related QOL including
`urinary function, urinary bother, bowel
`function, bowel
`bother, sexual function, and sexual bother. Each item is scored
`from 0 to 100, with higher scores representing better HRQOL.
`The SF-36 evaluates 8 domains of general QOL and well-be-
`ing, with summary scales for physical function, role limita-
`tions due to physical problems, bodily pain, general health,
`vitality, social functioning, role limitations due to emotional
`problems, mental health, physical health composite, and men-
`tal health composite. Again, each item is scored from 0 to 100,
`with higher scores indicating better outcomes. Reliability co-
`efficients for patients with prostate cancer range from 0.8 to
`0.95 for the UCLA-PCI and from 0.68 to 0.91 for the SF-
`36.10,11
`We compared demographic variables (age at diagnosis,
`race/ethnicity, level of education, number of comorbidities,
`body mass index [BMI], and insurance type) and pretreatment
`QOL scores on the SF-36 and UCLA-PCI scales for the periods
`1997 to 1999 and 2000 to 2003 and provided populations
`means for each scale as a reference.12,13 Patients were catego-
`rized as normal weight (BMI ⬍25), overweight (BMI 25 to
`29.9) or obese (BMI ⱖ30). Clinical information and treatment
`choice was gathered for all patients.
`Demographics and QOL scores were then analyzed by treat-
`ment choice and risk group (low, intermediate, or high) based
`on modified D’Amico risk categories.14 High-risk patients are
`those with PSA ⬎20 ng/mL or Gleason total grade 8 to 10 or
`Gleason primary grade 4 to 5 or clinical stage T3a. Intermedi-
`ate-risk patients are those with PSA 10.1 to 20 ng/mL or Glea-
`
`son total grade 7 or Gleason secondary grade 4 to 5 or clinical
`stage T2b to T2c. Low-risk patients are those with PSA ⱕ10
`ng/mL and Gleason total grade ⬍7 with no 4 to 5 pattern and
`clinical stage T1 to T2a.
`Patients’ pretreatment clinical and sociodemographic data
`were grouped by time category and compared using the ␹2
`test. The Student t test was used to compare mean pretreat-
`ment scores on the SF-36 and UCLA-PCI scales in the 2 time
`categories. This was done for the entire sample within risk
`groups.
`
`RESULTS
`
`DEMOGRAPHICS
`There were few demographic differences among
`patients diagnosed from 1997 to 1999 and those
`diagnosed from 2000 to 2003. Most patients in
`both periods were white, overweight, and aged 60
`to 70 years. Furthermore, the majority of patients
`in both periods had 1 to 2 comorbidities, had
`achieved a college-level education, and were cov-
`ered by private insurance. The percentage of pa-
`tients in other racial or ethnic groups decreased
`from 17% in 1997 to 1999 to 9% in 2000 to 2003,
`with a corresponding increase in white patients.
`This change in ethnic composition between the 2
`periods was statistically significant (P ⬍0.0001).
`The percentage of patients aged ⬍60 years in-
`creased from 23% in 1997 to 1999 to 28% in 2000
`to 2003, although this difference was not statisti-
`cally significant. Approximately 33% of all patients
`had ⱖ3 comorbidities in both periods, with only
`15% reporting no comorbidity. Only 25% of men
`diagnosed in 2000 to 2003 were of normal weight
`compared with 29% diagnosed in 1997 to 1999. Of
`patients with newly diagnosed prostate cancer,
`⬎60% report some level of college education, a
`mean that is higher than the national average of
`52% based on the 2000 US Census.15 In 2000 to
`2003, there were fewer patients with Medicare in-
`surance compared with the 1997 to 1999 period (P
`⬍0.03) (Table I).
`
`CLINICAL CHARACTERISTICS AND TREATMENT
`When clinical characteristics and treatment
`choices were analyzed, PSA and clinical T stage
`were both significantly lower in patients diag-
`nosed in 2000 to 2003 compared with 1997 to
`1999 (P ⬍0.01). In contrast, Gleason total score
`ⱕ7 was increased in patients diagnosed in 2000
`to 2003 (P ⬍0.01). Most patients diagnosed
`from 2000 to 2003 were at low risk (48%), with
`PSA ⱕ10 ng/mL (83%), clinical stage T1 (58%),
`and Gleason total score 5 to 6 (66%). Signifi-
`cantly more patients in 2000 to 2003 chose rad-
`ical prostatectomy and fewer chose radiation
`therapy (P ⬍0.05) as initial treatment for pros-
`tate cancer. Rates of hormonal therapy, watchful
`waiting, and cryotherapy were unchanged be-
`tween the 2 periods (Table II).
`
`UROLOGY 66 (Supplement 5A), November 2005
`
`77
`
`

`
`TABLE I. Pretreatment demographics by period
`1997–1999,
`2000–2003,
`n (%)
`n (%)
`
`76 (23)
`149 (46)
`102 (31)
`
`0 (0)
`5 (2)
`11 (3)
`36 (11)
`271 (83)
`3 (1)
`
`47 (15)
`80 (25)
`61 (19)
`136 (42)
`
`54 (17)
`169 (52)
`102 (31)
`
`93 (29)
`167 (52)
`62 (19)
`
`94 (30)
`54 (17)
`162 (52)
`1 (⬍1)
`
`590 (28)
`893 (42)
`659 (31)
`
`7 (⬍1)
`16 (1)
`27 (1)
`117 (5)
`1957 (91)
`18 (1)
`
`279 (13)
`538 (26)
`413 (20)
`866 (41)
`
`308 (15)
`1163 (56)
`623 (30)
`
`518 (25)
`1062 (51)
`496 (24)
`
`657 (32)
`252 (12)
`1064 (52)
`68 (3)
`
`Demographics
`Age at diagnosis (yr)
`⬍60
`60–70
`⬎70
`Race/ethnicity
`Native American
`Asian American
`Latino
`African American
`White
`Other
`Education level
`High school or less
`High school graduate
`Some college
`College graduate
`Comorbidities
`0
`1–2
`ⱖ3
`BMI category
`Normal (⬍25)
`Overweight (25–29)
`Obese (ⱖ30)
`Insurance
`Medicare supplement
`Medicare
`Private
`Other
`BMI ⫽ body mass index.
`
`P Value
`0.2261
`
`⬍0.0001
`
`0.9096
`
`0.4552
`
`0.1169
`
`0.0031
`
`HRQOL
`A significant difference in mean pretreatment
`urinary bother score (P ⬍0.05) was identified in
`the group of patients diagnosed in the 1997 to
`1999 period compared with those diagnosed in
`the 2000 to 2003 period, with patients in the
`later period reporting less bother. Mean pretreat-
`ment SF-36 scores did not differ significantly be-
`tween the 2 periods. When pretreatment scores
`on the UCLA-PCI and SF-36 were compared
`with published means, all patients across both
`time intervals were within 1 standard deviation
`of the mean on all scales. Cohort means were
`lower than population means on only 2 scales,
`sexual
`function and urinary bother on the
`UCLA-PCI (Tables III and IV).
`
`RISK STRATIFICATION
`There was no significant difference in risk be-
`tween the 2 periods. In 1997 to 1999, 42% of pa-
`tients were low risk, 30% were intermediate risk,
`and 20% were high risk at diagnosis. In the group
`of patients diagnosed in 2000 to 2003, 48% were
`
`low risk, 33% were intermediate risk, and 18%
`were high risk (Table II).
`When pretreatment demographic and QOL data
`were stratified by risk category, the low-risk group
`had significant differences between the 2 periods
`for race/ethnicity and BMI. For low-risk patients,
`there were significantly more white patients and
`fewer African American patients in 2000 to 2003
`compared with 1997 to 1999 (P ⬍0.05). There
`were fewer normal-weight patients and more obese
`patients in 2000 to 2003, although the percentage
`of overweight patients was unchanged between the
`periods (P ⬍0.01). There were no significant dif-
`ferences in the SF-36 or UCLA-PCI scores among
`low-risk patients in the 2 periods.
`For patients in the intermediate-risk group, pre-
`treatment demographics show significant differ-
`ences between the 2 periods for race/ethnicity and
`insurance status. Again, there were more white pa-
`tients and fewer African American patients in 2000
`to 2003 (P ⬍0.01). Additionally, fewer patients in
`2000 to 2003 had Medicare insurance (P ⬍0.05).
`The QOL scales showed significant differences
`for intermediate-risk patients in the 2 periods. For
`
`78
`
`UROLOGY 66 (Supplement 5A), November 2005
`
`

`
`TABLE II. Pretreatment clinical data and treatment choice by time interval
`Clinical
`1997–1999, n (%)
`2000–2003, n (%)
`First treatment
`Radical prostatectomy
`Cryosurgery
`Brachytherapy
`External beam radiation
`Orchiectomy
`LHRH agonist
`LHRH antagonist
`Antiandrogen
`5␣-reductase inhibitor
`Watchful waiting
`PSA category (ng/mL)
`ⱕ4
`4.1–10
`10.1–20
`⬎20
`Gleason total score
`2–4
`5–6
`7
`8–10
`T stage
`1
`2
`3
`Risk category
`132 (42)
`Low
`122 (39)
`Intermediate
`62 (20)
`High
`LHRH ⫽ luteinizing hormone–reducing hormone; PSA ⫽ prostate-specific antigen; T stage ⫽ tumor stage.
`
`1249 (58)
`73 (3)
`444 (21)
`214 (10)
`1 (⬍1)
`92 (4)
`2 (⬍1)
`14 (1)
`1 (⬍1)
`50 (2)
`
`328 (16)
`1401 (67)
`264 (13)
`90 (4)
`
`22 (1)
`1410 (66)
`556 (26)
`144 (7)
`
`1236 (58)
`885 (41)
`20 (1)
`
`1020 (48)
`705 (33)
`381 (18)
`
`171 (52)
`7 (2)
`88 (27)
`43 (13)
`0 (0)
`9 (3)
`2 (1)
`2 (1)
`1 (⬍1)
`4 (1)
`
`46 (15)
`187 (60)
`55 (18)
`22 (7)
`
`11 (3)
`213 (66)
`77 (24)
`20 (6)
`
`141 (43)
`178 (54)
`8 (2)
`
`P Value
`0.0110
`
`0.0083
`
`0.0059
`
`⬍0.0001
`
`0.0807
`
`TABLE III. University of California–Los Angeles Prostate Cancer Index pretreatment scales by
`period compared with age-appropriate reference means*
`1997–1999
`2000–2003
`Patients (n)
`Mean Score
`Patients (n)
`Mean Score
`322
`90
`2118
`89
`322
`88
`2127
`88
`307
`60
`2046
`60
`316
`50
`2083
`51
`321
`82
`2099
`85
`320
`93
`2099
`92
`
`Reference
`Mean Score
`89
`88
`53
`54
`86
`92
`
`P Value
`0.68
`0.46
`0.82
`0.44
`0.03
`0.49
`
`Variable
`Bowel bother
`Bowel function
`Sexual bother
`Sexual function
`Urinary bother
`Urinary function
`
`Adapted from J Urol.12
`* The mean age of Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) patients in this analysis is 65.1 years (median 65.0 years).
`
`the SF-36 inventory, scores for 2000 to 2003 were
`higher in the mental composite score, mental
`health, role emotional, and social function scales
`compared with 1997 to 1999 (P ⬍0.05). On the
`UCLA-PCI, the urinary bother scale had a higher
`mean score in 2000 to 2003 period compared with
`1997 to 1999 (P ⬍0.05). In the high-risk group,
`there were no significant difference is patient de-
`mographics or QOL scores between the 2 periods
`(Table V).
`
`When all years were combined and demograph-
`ics were stratified by risk group, age at diagnosis,
`race/ethnicity, education, and insurance were sig-
`nificantly different. Low-risk patients tended to be
`white, younger, with some college education, and
`private insurance. In contrast, the high-risk cate-
`gory contained a higher percentage of men who
`were older, who had high school education or less,
`and who had Medicare or Medicare supplement
`insurance. Additionally, a higher percentage of in-
`
`UROLOGY 66 (Supplement 5A), November 2005
`
`79
`
`

`
`TABLE IV. Pretreatment Rand Medical Outcomes Study 36-Item Short Form scales by period
`compared with age-appropriate reference means*
`1997–1999
`2000–2003
`Patients
`Mean Score
`Patients
`Mean Score
`324
`84
`2109
`84
`324
`70
`2087
`72
`313
`51
`2004
`52
`319
`77
`2125
`78
`313
`51
`2004
`51
`321
`85
`2105
`85
`320
`80
`2107
`83
`320
`79
`2114
`80
`325
`86
`2111
`88
`319
`66
`2126
`67
`
`Reference
`Mean Score
`68
`58
`50
`77
`50
`65
`76
`59
`79
`57
`
`P Value
`0.79
`0.09
`0.09
`0.07
`0.93
`0.99
`0.15
`0.66
`0.12
`0.40
`
`Variable
`Bodily pain
`General health
`Mental composite score
`Mental health
`Physical composite score
`Physical function
`Role emotional
`Role physical
`Social function
`Vitality
`
`Adapted from SF-36 Health Survey: Manual & Interpretation Guide.13
`* The mean age of Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) patients in this analysis is 65.1 years (median 65.0 years).
`
`TABLE V. Comparison of pretreatment demographics by period and risk category
`Intermediate
`Risk
`1997–
`2000–
`1999
`2003
`(%)
`(%)
`
`Low Risk
`1997–
`2000–
`1999
`2003
`(%)
`(%)
`
`P Value
`0.11
`
`P Value
`0.43
`
`High Risk
`1997–
`2000–
`1999
`2003
`(%)
`(%)
`
`Demographic
`Age at diagnosis (yr)
`⬍60
`60–70
`⬎70
`Race/ethnicity
`Native American
`Asian American
`Latino
`African American
`White
`Other
`Education level
`High school or less
`High school graduate
`Some college
`College graduate
`Comorbidities
`0
`1–2
`ⱖ3
`BMI
`Normal (⬍25)
`Overweight (25–29)
`Obese (ⱖ30)
`Insurance
`Medicare supplement
`Medicare
`Private
`Other
`BMI ⫽ body mass index.
`
`27
`54
`19
`
`0
`2
`2
`11
`85
`1
`
`12
`27
`20
`41
`
`18
`53
`29
`
`32
`55
`13
`
`26
`12
`60
`1
`
`32
`44
`24
`
`0
`1
`1
`4
`93
`1
`
`10
`25
`21
`45
`
`16
`56
`28
`
`24
`52
`24
`
`30
`10
`57
`3
`
`0.03
`
`0.74
`
`0.76
`
`0.01
`
`0.44
`
`21
`46
`33
`
`0
`0
`6
`11
`83
`1
`
`18
`22
`16
`44
`
`14
`53
`33
`
`23
`51
`26
`
`33
`20
`47
`0
`
`26
`40
`34
`
`0
`1
`1
`5
`92
`1
`
`17
`26
`18
`38
`
`15
`54
`31
`
`26
`52
`22
`
`34
`13
`50
`4
`
`0.06
`
`0.60
`
`0.91
`
`0.65
`
`0.04
`
`16
`31
`53
`
`0
`5
`0
`11
`82
`2
`
`13
`27
`21
`39
`
`15
`52
`34
`
`31
`48
`21
`
`34
`24
`41
`0
`
`19
`38
`43
`
`0
`1
`2
`9
`88
`1
`
`15
`28
`19
`37
`
`12
`58
`30
`
`25
`48
`26
`
`36
`16
`44
`4
`
`80
`
`UROLOGY 66 (Supplement 5A), November 2005
`
`P Value
`0.31
`
`0.08
`
`0.95
`
`0.62
`
`0.56
`
`0.18
`
`

`
`TABLE VI. Comparison of demographics by risk group: 1997–2003
`Demographics
`Low Risk, n (%)
`Intermediate Risk, n (%)
`High Risk, n (%)
`Age at diagnosis (yr)
`⬍60
`60–70
`⬎70
`Race/ethnicity
`Native American
`Asian American
`Latino
`African American
`White
`Other
`Education level
`High school or less
`High school graduate
`Some college
`College graduate
`Comorbidities
`0
`1–2
`ⱖ3
`BMI
`Normal (⬍25.0)
`Overweight (25.0–29.0)
`Obese (ⱖ30.0)
`Insurance
`Medicare supplement
`Medicare
`Private
`Other
`BMI ⫽ body mass index.
`
`P Value
`⬍0.0001
`
`0.0208
`
`⬍0.0001
`
`0.1643
`
`0.8491
`
`⬍0.0001
`
`89 (18)
`187 (38)
`217 (44)
`
`1 (⬍1)
`6 (1)
`7 (1)
`49 (10)
`423 (86)
`6 (1)
`
`76 (16)
`132 (28)
`95 (20)
`177 (37)
`
`60 (12)
`277 (57)
`146 (30)
`
`128 (27)
`232 (49)
`115 (24)
`
`172 (37)
`73 (16)
`199 (43)
`16 (3)
`
`363 (31)
`529 (45)
`281 (24)
`
`4 (⬍1)
`10 (1)
`14 (1)
`61 (5)
`1074 (92)
`10 (1)
`
`121 (10)
`288 (25)
`237 (21)
`509 (44)
`
`191 (17)
`638 (55)
`324 (28)
`
`292 (26)
`593 (52)
`260 (23)
`
`334 (30)
`121 (11)
`648 (57)
`26 (2)
`
`217 (24)
`366 (41)
`303 (34)
`
`2 (⬍1)
`5 (1)
`20 (2)
`54 (6)
`800 (90)
`5 (1)
`
`154 (18)
`220 (25)
`151 (17)
`341 (39)
`
`125 (14)
`470 (54)
`271 (31)
`
`219 (26)
`442 (52)
`192 (23)
`
`294 (35)
`112 (13)
`410 (49)
`25 (3)
`
`termediate- or high-risk patients were Latino or
`African American (Table VI).
`
`DISCUSSION
`Based on this above analysis, the average prostate
`cancer patient diagnosed currently is aged 65
`years, white, overweight, and educated at a level
`above the national average,15 with 1 to 2 comor-
`bidities and private insurance. Most patients
`present at an early clinical stage, with a PSA ⬍10
`ng/mL, and may be classified as low risk. Further-
`more, newly diagnosed patients will report average
`to above-average HRQOL at the time of diagnosis
`based on widely validated scales. Men in this study
`generally scored at or above national means for
`sexual, urinary, and bladder function and bother
`on the UCLA-PCI inventory.12 Similarly, patients
`in the CaPSURE cohort scored at or above pub-
`lished means for age-matched populations on the
`SF-36.13 The improvement in urinary and sexual
`function domains noted in more contemporary pa-
`tients may reflect the increasing use of screening in
`asymptomatic patients instead of limiting screen-
`ing to those presenting to urologists with symp-
`toms such as urinary changes and sexual function.
`
`Not surprisingly, increasing risk category corre-
`lated with older patient age at diagnosis and eth-
`nicity. African American and Latino men are
`known to be at increased risk of prostate cancer
`diagnosis and death, and generally present at a
`later stage.1 Level of education has been correlated
`with increased prostate cancer screening, which
`may explain why higher level of educational attain-
`ment correlates with lower risk.16 The explanation
`for the significant association between insurance
`status and increased risk may reflect increased pa-
`tient age, as older patients are more likely to have
`Medicare insurance, although this area merits fur-
`ther investigation.
`Despite the well-documented stage migration in
`prostate cancer, more patients in this study chose
`radical prostatectomy as initial treatment. In con-
`trast, the percentage of patients who chose watch-
`ful waiting was low (1% to 2%) and unchanged
`across the periods examined. These findings may
`be a reflection of the CaPSURE cohort, in which
`patients are recruited by urologists at the time of
`prostate cancer diagnosis. Several reports have
`shown that patient treatment choice tends to re-
`flect physician specialty.17,18 Of interest is the fact
`
`UROLOGY 66 (Supplement 5A), November 2005
`
`81
`
`

`
`that many men are overweight or obese and have
`significant associated comorbidities. Such patients
`are more likely to have competing causes of death
`and present with worse QOL not only at baseline
`but also over time.19,20
`With the combination of generally average to
`above-average HRQOL and low-risk disease, men
`with newly diagnosed prostate cancer face the pos-
`sibility of significant decline in QOL with all forms
`of treatment with the possible exception of active
`surveillance. In contrast, men with early-stage dis-
`ease have excellent chances for cure with many
`different choices of therapy. Physicians should
`consider baseline QOL and patient age and health
`status when counseling them about treatment
`choices.
`
`CONCLUSION
`The results of our investigation indicate that the
`average prostate cancer patient is low-risk, edu-
`cated at a level above the national mean, with av-
`erage to above-average scores on all domains of
`widely validated QOL scales. The dual goals of
`treatment for newly diagnosed prostate cancer in
`the 21st century will be to cure the patient’s disease
`while maximizing and maintaining HRQOL.
`
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