| Controversy exists in prostate cancer (PrCA) in screening recommendations, treatment and survival. These issues, from understanding the etiology of PrCA to communicating complicated matters in risk assessment, constitute one of the most difficult areas in epidemiology. This dissertation was designed to provide some insight in these areas. These issues are of greatest concern and are most amenable to study in populations at very high-risk of poor-prognosis disease. The descriptive epidemiology of PrCA in SC warrants further investigation into the associations of PrCA survival with treatment, grade, and stage of disease among men disproportionately affected. The purpose was to determine: (1) if AA men are diagnosed with PrCA at younger ages, with more aggressive disease than EA men in SC using time-to-event methodology; (2) whether survival differs by treatment and race; and (3) the social and clinical predictors of racial differences in all-cause and PrCA-related survival.; In the first investigation, we found AA men are diagnosed at earlier ages regardless of grade of disease. Many of the racial differences are present among the older men (65+ years), and that the effects of education and poverty significantly predict the hazard of time-to-event (TTE) for certain age groups between races.; When assessing survival by treatment, a greater proportion of AA men received hormonal therapy, which is associated with lower survival probabilities and a higher hazard for death compared to other treatments. The effect of grade on the hazard for death decreases as age at diagnosis increases.; In lifetime survival analyses, African-American men diagnosed with PrCA were found to die of PrCA-related conditions and other causes of death by as many as six years earlier than European-American men. After adjustment for clinical variables, we found the racial disparity in risk of death remained.; In conclusion, AA men in SC are diagnosed at younger ages regardless of grade compared to EA men. AA men have poorer survival for PrCA-related death for treatments assessed and poorer lifetime survival compared to EA men. Future analyses should include information on comorbidities and influences of treatment decisions to determine if the differences can be reduced. |
