AUA 2021: Racial Disparity in The Utilization of New Therapies for Advanced Prostate Cancer

( The treatment landscape in advanced prostate cancer has rapidly evolved. In the context of metastatic castration-resistant prostate cancer (mCRPC), docetaxel was the first agent to demonstrate a survival benefit when combined with conventional androgen deprivation therapy (ADT). Following this, a number of other treatment approaches have been assessed and are now clinically used including androgen receptor targeting agents, immunotherapy approaches, and targeted therapy. In 2010, Sipuleucel-T immunotherapy was the first FDA-approved agent after docetaxel for mCRPC.

The burden of prostate cancer mortality is borne unequally – in particular, Black and Hispanic patients have a high burden of prostate cancer mortality. While there may be some underlying genetic differences, access to care appears to underpin the majority of discrepancies in treatment outcomes.

In a podium presentation at the American Urologic Association (AUA) Virtual Annual Meeting, Dr. Mouzannar and colleagues assessed whether there was disparity in the utilization of immunotherapy in the treatment of black and Hispanic patients with mCRPC.

To do so, they used the National Cancer Database to identified patients between 2010-2015 with likely minimally/asymptomatic mCRPC based on the following criteria PSA 50-200ng/ml, Charlson 0-2, age <70, stage M1, treated with chemotherapy or immunotherapy. The authors examined annual trends for chemotherapy and immunotherapy use and compared utilization by demographic and clinical features. Multivariate analysis was performed to determine predictors of receiving immunotherapy vs chemotherapy.

The authors identified 1238 patients of whom most were Non-Hispanic white (63%), with private insurance (46.4%).

Overall, there was increased utilization of immunotherapy from 2010 to 2013 (from 3.8% to 39.8%), followed by a decrease to 10.9% in 2015. Simultaneously, there was decreased utilization of chemotherapy from 2010 to 2013 (from 96.2% to 60.2%).

The increased use of immunotherapy was predominantly in white patients and not seen in black and Hispanic patients.


Relative to chemotherapy, immunotherapy was less likely to be used in a comprehensive community cancer program (OR 0.52, 95% CI 0.30 – 0.89), and patients with mid-high SES (OR 0.49, 95% CI 0.31 – 0.78).

The authors conclude that, while FDA approval of Sipuleucel-T led to increased utilization of immunotherapy shortly thereafter, this predominately restricted to white patients.

Presented by: Ali Mouzannar, MD, Urology Resident, University of Miami

Written by: Christopher J.D. Wallis, University of Toronto, Twitter: @WallisCJD during the 2021 American Urological Association, (AUA) Annual Meeting, Fri, Sep 10, 2021 – Mon, Sep 13, 2021.