AUA 2017: Racial Disparities in Delivering Definitive Therapy for Intermediate-High Risk Localized Prostate Cancer

Boston, MA (UroToday.com) African American populations are historically reported to be at an increased risk for high-grade, high-volume prostate cancer, (PC) with its attendant impact on prostate cancer specific mortality. Dr. David F. Friedlander reports a population-based study, suggesting that the significant disparity in African American populations may be attributable to a lower rate of definitive therapies, such as those of radical prostatectomy and/or radiation therapy.

283,153 men (n= 59,262 African American and n=223,873 Caucasian) diagnosed with high-risk PC between January 2002 and December 2013 were identified in the National Cancer Database. All men were >40 years of age, with biopsy-confirmed localized intermediate to high risk PC. Sensitivity and subgroup analyses were performed to adjust for inherent patient and facility-level differences.

Throughout the study period, Caucasian men received a consistently higher proportion of definitive therapies: 82.9% in Caucasian men versus 73.7% in African American over a 10- year period. Unsurprisingly, rates of definitive therapy during that time increased for both groups.

Overall, patient demographics (insurance type, income level, etc) and clinco-pathlogical factors (PSA at time of diagnosis, Gleason grade, etc) had significant predictive relevance in the designation to definitive therapies. Ultimately, 34% of facilities appeared to favor Caucasian men for definitive treatment while only 1% facilities favored African American men for similar treatment. Despite adjusting in multivariate analysis, this disparity remains significant.

Citing the Medicare Access and CHIP Reauthrization Act of 2015 (MACRA) and the USPSTF grade D recommendation, Dr. Friedlander advocates for the need of ongoing health reform efforts. Despite continued progress towards equal access healthcare, the implications of racial disparities present an opportunity to improve both functional and oncological outcomes in PC.

Authors: David F. Friedlander, Nicolas von Landenberg, Philipp Gild, Quoc-Dien Trinh, Patrick Karabon, Maxine Sun, Paul L. Nguyen, Adam S. Kibel, Toni K. Choueiri, Joel S. Weissman, Mani Menon, Firas Abdollah

Presented by: David F. Friedlander (MD) of Brigham and Women's Hospital

Written By: Linda Huynh (BS), an assistant research specialist from the University of California, Irvine, on behalf of UroToday.com

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA

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