When a man is diagnosed with prostate cancer, he can wait and see how it develops (often called watchful waiting), have a prostatectomy, or be treated with radiation therapy. Doctors take into account many medical factors—such as the age of the patient and how far the cancer has progressed—in making a treatment decision. But now, research from the University of Colorado Health Sciences Center finds that nonmedical factors, such as the patient's marital status and ethnicity, could also play a role in how the cancer is treated.

What they wanted to know: What factors influence how a man is treated for prostate cancer?

What they did: The researchers used data from Medicare to compare the number of men who had immediate treatment versus those who watched and waited, and, of those who were treated, who had radiation therapy versus those who had a prostatectomy. They looked at age, marital status, tumor size, ethnicity, and socioeconomic status to see if any of those factors predicted what type of treatment the men received. Doctors are more likely to want to treat a tumor immediately if the patient is young or the tumor is advanced, because there is more potential or time for the tumor to grow.

What they found: As expected, younger age and larger tumors made men more likely to have treatment rather than watchful waiting. However, more surprisingly, married men were more likely than singles to have treatment regardless of age and tumor size, and specifically more likely to have a prostatectomy. Blacks and Latinos were just as likely as whites to have immediate treatment. But blacks were less likely to have a prostatectomy, whereas Latinos were more likely to have a prostatectomy rather than radiation therapy.

What it means to you: While less often talked about, cultural factors can play a large part in medical decisions both for doctors and patients. Previous research has found that black patients, for example, are more likely to distrust physicians and fear surgery for cancer more than other groups, so black patients may be more likely to refuse surgery or, having encountered patients with these fears, doctors may adjust their recommendations based on race. The bottom line is that all patients should talk to their doctors about treatment options to decide what is best for them.

Caveats: The data that the researchers worked with was somewhat limited because it said nothing about the type of doctors giving care, or whether the patients had chosen what type of care they got. So, it's hard to tell why different demographic characteristics could lead to different treatment decisions.

Read the article: Denberg, T.D. et al. "Marriage and Ethnicity Predict Treatment in Localized Prostate Carcinoma." Cancer. Published online March 28, 2005.

Abstract online: http://www3.interscience.wiley.com