SES AUA 2022: Examining The Intersections Of Race, Ethnicity, And Insurance Status With Metastatic Prostate Cancer At Presentation

( The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Caleb Bercu examining the intersections of race, ethnicity, and insurance status with metastatic prostate cancer at presentation. One out of eight men will be diagnosed with prostate cancer in the United States, with the most critical indicator for treatment modality and mortality being the stage of prostate cancer at diagnosis. Currently, the intersectional relationships of race, socioeconomic status, and insurance status with the presentation of metastatic prostate cancer have yet to be elucidated. The aim of this study was to identify inequities between socioeconomic and demographic variables related to presentation of stage IV prostate cancer.

 For this study, patient data was assessed from the National Cancer Database between 2004 to 2017. Logistical regression assessed the relationships of age, race, ethnicity, geographic location, education level, income, and insurance status and stage IV prostate cancer at presentation. Interactions of demographic and socioeconomic variables were designated as significant where alpha level = 0.01 and included in the final predictive model.

 Overall, 7% of 1,275,410 prostate cancer patients were diagnosed with stage IV disease at presentation. The relationship between race and insurance status with stage IV prostate cancer at presentation differed significantly (two-way interaction, p-value <0.0001). Amongst Hispanic men, uninsured patients were 2.5 times more likely to present with stage IV prostate cancer compared to privately insured individuals (OR 3.45, 95%, 3.14-3.82). Uninsured Non-Hispanic White men were 2.41 times as likely to present with stage IV prostate cancer compared to privately insured Non-Hispanic White men (OR 2.31-2.52). Uninsured Non-Hispanic Black men were 2.75 times more likely to present with metastatic prostate cancer compared to privately insured individuals of the same race and ethnicity (OR 2.58-2.93). Furthermore, increased income (OR of metastatic prostate cancer by income <$30,000 versus $46,000+) is a protective factor against metastatic prostate cancer for Non-Hispanic Black and Non-Hispanic White men.

A decrease in PSA screening is attributed to the grade D recommendation against PSA screening published in 2012 by the United States Preventative Services Task Force (USPSTF). From 2004 through 2017, Non-Hispanic Black and Hispanic men constituted the largest percentage of patients presenting with metastatic prostate cancer:


SES AUA22_Bercu 


Non-Hispanic Black and Hispanic populations sustained the largest increases of change per year of metastatic prostate cancer at presentation in comparison of the pre- and post-grade D eras (slope difference between eras p < 0.001). Increased risk of presenting with metastatic prostate cancer highlights disparities for racial and ethnic minorities in the post-screening era. Racial and ethnic differences may reflect systemic barriers to early diagnosis of prostate cancer with possible factors being social and economic disparities.


Dr. Bercu concluded his presentation with the following take-home messages:

  • Uninsured Hispanic and Black individuals had a larger odds ratio of presenting with metastatic disease compared to their White counterparts
  • Furthermore, men < 60 years of age (uninsured) were 4.5 times more likely to present with metastatic prostate cancer than those privately insured
  • Lack of insurance is correlated with late stage of presentation
  • Targeted public health efforts and heightened awareness of sociodemographic, ethnic, and racial inequities may lead to improved management of prostate cancer in at risk populations


Presented By: Caleb Bercu, Department of Urology, Wake Forest Baptist Health, Winston Salem, NC

Co-Authors: Ram Pathak1, Deven Champaneri2, Adam Cohen1, Matvey Matvey1, Shuo Liu1, Sarah Birken1, Timothy Craven1, Ashok Hemal1
Affiliations: 1Wake Forest Baptist Health, 2Edward Via College of Osteopathic Medicine

Written By: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 86th Annual Meeting of the Southeastern Section of the American Urological Association, San Juan, PR, Mar 16 – 19, 2022