Prostate cancer disparities among American Indians/Alaskan Natives in the United States.

Americans Indians and Alaska Natives face disparities in cancer care with lower rates of screening, limited treatment access, and worse survival. Prostate cancer treatment access and patterns of care remain unknown.

We utilized Surveillance, Epidemiology, and End Results (SEER) data to compare incidence, primary treatment, and cancer-specific mortality across American Indian/Alaska Native, Asian/Pacific Islander, Black, and White patients. Baseline characteristics included prostate specific antigen (PSA), Gleason score (GS), tumor stage, 9-level Cancer of the Prostate Risk Assessment (CAPRA-9) risk score, county characteristics, and healthcare provider density. Primary outcomes were first definitive treatment and prostate cancer specific mortality (PCSM).

American Indian/Alaska Native patients were most diagnosed with higher PSA, ≥GS8, ≥cT3, high risk prostate cancer (CAPRA ≥ 6), and metastases at diagnosis than any other group. Adjusting for age, PSA, GS, and clinical stage, American Indian/Alaska Native patients with localized prostate cancer were more likely to undergo external beam radiation than radical prostatectomy and had the highest rates of no documented treatment. 5-year prostate cancer specific mortality (PCSM) was higher among American Indian/Alaska Natives than any other racial group. However, after multivariable adjustment accounting for clinical and pathologic factors, county-level demographics, and provider density, American Indian/Alaska Native PCSM hazards were no different that White patients'.

American Indian/Alaska Native patients have more advanced prostate cancer, lower rates of definitive treatment, higher mortality, and reside in areas of less specialty care. Disparities in access account for excess risks of PCSM. Focused health policy interventions are needed to address these disparities.

Journal of the National Cancer Institute. 2023 Jan 11 [Epub ahead of print]

Carissa E Chu, Michael S Leapman, Shoujun Zhao, Janet E Cowan, Samuel L Washington, Matthew R Cooperberg

Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Urology, Yale University, New Haven, CT, USA., Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.