Sociodemographic factors associated with postprostatectomy radiotherapy TL Krupski 1,2 *, L Kwan 1,2 & MS Litwin 1,2 1 Department of Urology, David Geffen School of Medicine, School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, USA; and 2 Department of Health Services, David Geffen School of Medicine, School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, USA Purpose: To determine if nonclinical factors affect the use of adjuvant radiation therapy after surgical resection of the prostate gland. Methods: Using the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) public use data files, we identified men with localized/ regional prostate cancer who underwent postprostatectomy radiotherapy within 4 months of surgery. We used 2000 Census information to ascribe a median education and income level to these men based on the county of residence and ethnicity. Results: Of 34 763 men who underwent surgical resection, 1549 received postprostatectomy radiotherapy. Those with higher tumor grade and from certain geographic regions (Seattle and Hawaii) had significantly higher rates of radiotherapy while being older and from other geographic regions (Detroit, Utah, and New Mexico) was protective. The use of additional radiation therapy was not affected by ethnicity, income level, or educational attainment. Conclusions: We found no socioeconomic or demographic disparities in the receipt of postprostatectomy radiotherapy. Geographic variation in postprostatectomy radiotherapy may be explained by limited evidence supporting its use in clinical practice. Prostate Cancer and Prostatic Diseases (2005) 8, 184–188. doi:10.1038/sj.pcan.4500791 Published online 5 April 2005 Keywords: prostate cancer; adjuvant radiation; outcomes; socioeconomic; disparity Introduction Recurrence rates following primary treatment for pros- tate cancer range from 5 to 30%, regardless of which therapy is chosen. 1–4 Patients deemed high risk for recurrence after primary treatment often receive adju- vant radiation therapy, defined as additional therapy administered immediately following primary treatment. Following radical prostatectomy, the presence of adverse pathologic features such as high Gleason grade, extra- capsular extension, or a positive margin usually compels clinicians to advise a course of adjuvant radiation therapy. 5–7 Adverse pathologic features in a radical prostatectomy specimen are likely the result of either aggressive tumor biology or poor patient selection. Although pretreatment PSA, Gleason score, and clinical stage are all used to predict pathologic stage and prognosis, they are not infallible. 8 Clinicians are continually evaluating novel combinations of clinical variables in a quest to improve prognostication. Nonclinical variables associated with cancer control include African American ethnicity. African Americans ethnicity has been associated with lower disease-free survival rates. 9,10 The association of ethnicity with prognosis is mitigated when researchers control for stage at presentation. 11,12 Using military rank as a surrogate for socioeconomic status, Tarman et al 13 found no association between socioeconomic status and biochemical recurrence rates. While many experts Received 29 September 2004; revised 11 January 2005; accepted 21 January 2005; published online 5 April 2005 *Correspondence: TL Krupski, UCLA Department of Urology, Box 951738, Los Angeles, CA 90095-1738, USA. E-mail: tkrupski@mednet.ucla.edu Prostate Cancer and Prostatic Diseases (2005) 8, 184–188 & 2005 Nature Publishing Group All rights reserved 1365-7852/05 $30.00 www.nature.com/pcan