Racial differences in perceived cancer aggressiveness and factors important in treatment decision making account for a large portion of known racial disparities in prostate cancer between African American (AA) and white men, a new study found. Researchers examined a prospective, population-based cohort of 1,170 men with newly diagnosed nonmetastatic prostate cancer enrolled from 2011 to 2013 before treatment. Each participant was asked to rate the aggressiveness of his cancer, with his response compared to the actual diagnosis based on a medical record review. Participants were also asked to rate the importance of 10 factors for their treatment decision-making process. Among the findings:

• Among AA and white patients with low-risk cancer, 78-80% perceived their cancers to be “not very aggressive.”
• However, among high-risk patients, 54% of AA patients considered their cancers to be “not very aggressive” while 25% of white patients did.
• AA patients were significantly more likely to consider cost, treatment time, and recovery time as very important in the decision-making process.
• In multivariable analysis, perceived cancer aggressiveness and cure as the most important factor were significantly associated with receiving any aggressive treatment and were associated with surgery.