Time from biopsy to radical prostatectomy by race in an equal-access healthcare system: Results from the SEARCH cohort.

We previously showed that within an equal-access health system, race was not associated with the time between prostate cancer (PC) diagnosis and radical prostatectomy (RP). However, in the more recent time-period of the study (2003-2007), Black men had significantly longer times to RP. We sought to revisit the question in a larger study population with more contemporary patients. We hypothesized that time from diagnosis to treatment would not differ by race, even after accounting for active surveillance (AS) and the exclusion of men at very low to low risk of PC progression.

We analyzed data from 5885 men undergoing RP from 1988 to 2017 at eight Veterans Affairs Hospitals from SEARCH. Multiple linear regression was used to compare time from biopsy to RP and to examine the risk of delays (>90 and >180 days) between races. In sensitivity analyses we excluded men deemed to have initially chosen AS based on having >365 days from biopsy to RP and men at very low to low PC risk for progression according to National Comprehensive Cancer Network Clinical Practice Guidelines.

At biopsy, Black men (n = 1959) were younger, had lower body mass index, and higher prostate specific antigen levels, (all p < 0.02), compared to White men (n = 3926). Time from biopsy to RP was longer in Black men (mean days: 98 vs. 92; adjusted ratio of mean number of days, 1.07 [95% confidence interval: 1.03-1.11], p < 0.001); however, there were no differences in delays >90 or >180 days after adjusting for confounders (all p ≥ 0.286). Results were similar following the exclusion of men potentially under on AS and at very low and low risk.

In an equal-access healthcare system, we did not find evidence of clinically relevant differences in time from biopsy to RP in Black versus White men.

The Prostate. 2023 Apr 25 [Epub ahead of print]

Victor Pereira, Taofik Oyekunle, Jessica Janes, Christopher J Amling, William J Aronson, Matthew R Cooperberg, Christopher J Kane, Martha K Terris, Zachary Klaassen, Stephen J Freedland, Adriana C Vidal, Ilona Csizmadi

Urology Section, Durham VA Medical Center, Durham, North Carolina, USA., Division of Urology, Oregon Health Sciences University, Portland, Oregon, USA., Department of Surgery, Urology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA., Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA., Urology Department, University of California San Diego Health System, San Diego, California, USA., Section of Urology, Veterans Affairs Health Care System, Augusta, Georgia, USA., Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA., Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.