Prostate cancer poses significant burdens of mortality and morbidity on black men, greater than in while men, especially in the southeastern US. Prostate cancer in black men is diagnosed at a later state, with consequently a worse prognosis. This study will build on our previous studies on prostate cancer in elderly black men, and use similar methods to our study of rectal carcinoma. Our specific questions (controlling for potential confounders) are: 1) Do black men receive less aggressive treatment for localized prostate cancer than white men? 2) Do black men with prostate cancer have a history of less frequent screening with prostate specific antigen (PSA) and white men with prostate cancer? 3) Are knowledge, attitudes and beliefs regarding PSA screening and treatment different black and white men with prostate cancer? We will conduct a case-case study of 300 incident cancer among black men and 300 incident cases of prostate cancer among white men age 65 and older in a 33 county area of North Carolina. Cases will be identified from the North Carolina Central Cancer Registry. After obtaining permission from the patient's physician, we will obtain medical records and conduct a detailed telephone interview to assess demographics; income and poverty levels; education; level of social support; attitudes toward screening tests, especially cancer screening; access to health care; history of use of prostate and other screening tests compared with use of PSA as a diagnostic test; stage of cancer and types of treatments used. This study will determine: 1) whether initial treatment could account for these racial disparities in treatment outcomes, and 2) whether attitudes toward screening tests in general, and prostate cancer in particular, or other factors appear to explain these differences. This examination of the multiple possible factors for which race may serve as an indicator will substantially improve our understanding of racial disparities in prostate cancer, leading to targeted interventions.
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