EURURO Vol. 72 No. 2

307 320

Prostatic Disease
Racial Variation in Patient-Reported Outcomes Following
Treatment for Localized Prostate Cancer: Results from the
CEASAR Study
Mark D. Tyson [2_TD$DIFF] JoAnn Alvarez [1_TD$DIFF] Tatsuki Koyama Karen E. Hoffman
Matthew J. Resnick Xiao-Cheng Wu Matthew R. Cooperberg Michael Goodman
Sheldon Greenfield Ann S. Hamilton Mia Hashibe Lisa E. Paddock Antoinette Stroup
Vivien W. Chen [4_TD$DIFF] David F. Penson Daniel A. Barocas
a Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; bDepartment of Biostatistics, Vanderbilt University School of
Medicine, Nashville, TN, USA; c Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; dDepartment of
Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA; e The Geriatric Research, Education, and Clinical Center, Tennessee Valley
Veterans Affairs Health Care System, Nashville, TN, USA; f School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA;
g Department of Urology, University of California, San Francisco Medical Center, San Francisco, CA, USA; hDepartment of Epidemiology, Rollins School of
Public Health, Emory University, Atlanta, GA, USA; i Center for Health Policy Research and Department of Medicine, University of California, Irvine, CA, USA;
j Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; k Department of Family and Preventive
Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; l Rutgers Cancer Institute of New Jersey, Rutgers University, New
Brunswick, NJ, USA
ava ilable at
journal homepage:
Article info
Article history:
Accepted October 20, 2016
Associate Editor:
James Catto
Keywords:
Prostate cancer
Active surveillance
Surgery
Radiation
Comparative effectiveness
Patient-reported function
Abstract
Background: Relatively little is known about the relationship between race/ethnicity
and patient-reported outcomes after contemporary treatments for localized prostate
cancer.
Objective: To test the hypothesis that treatment-related changes in urinary, bowel,
sexual, and hormonal function vary by race/ethnicity.
Design, setting, and participants: The Comparative Effectiveness Analysis of Surgery and
Radiation (CEASAR) study is a prospective, population-based, observational study that
enrolled 3708 men diagnosed with localized prostate cancer in 2011–2012.
Outcome measurements and statistical analysis: Patient-reported disease-specific func-
tion was measured using the 26-item Expanded Prostate Index Composite (EPIC) at
baseline and 6 and 12 mo after enrollment. Mean treatment differences in function were
compared by race using risk-adjusted generalized estimating equations.
Results and limitations: While all race/ethnic groups reported considerable declines in
scores for urinary incontinence after radical prostatectomy (RP) when compared to
active surveillance, African-American men reported a greater difference than white men
did (adjusted difference-in-differences 8.4 points, 95% confidence interval 2.0–14.8;
p = 0.01). No difference in bother scores was noted and the overall proportion of
explained variation attributable to race/ethnicity was relatively small in comparison
to primary treatment and baseline function. No clinically significant racial variation was
noted for the sexual, bowel, irritative voiding, or hormone domains. Limitations include
the lack of well-established thresholds for clinical significance using the EPIC instru-
ment.
* Corresponding author. Department of Urologic Surgery, Vanderbilt University Medical Center,
A1302 Medical Center North, Nashville, TN 37203, USA. Tel. +1 615 3222880; Fax: +1 615 3439815.
E-mail address: (M.D. Tyson).
0302-2838/# 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.