TOPLINE

In a real-world analysis of US men with prostate cancer, Black patients were less likely than White patients to receive several treatments, and distance from a major cancer center was associated with treatment patterns and likelihood of metastasis.

METHODOLOGY

• Outcomes in prostate cancer vary by race, geography, income, and education, but real-world data on how these factors affect treatment are limited. The National Institutes of Health’s All of Us Research Program offers a diverse national cohort to examine these disparities.
• Researchers identified 6271 participants with prostate cancer (median age at diagnosis, 66 years) from the All of Us program. They were stratified by race, ethnicity, income, educational attainment, and distance from a National Cancer Institute (NCI)-designated cancer center (< 40 miles, 40-80 miles, or > 80 miles).
• Use of androgen deprivation therapy, androgen receptor pathway inhibitors (ARPIs), bone-targeting agents, chemotherapy, prostatectomy, and radiotherapy was identified from electronic health records.
• The researchers assessed treatment use, time-to-treatment, time-to-metastasis, and availability of genomic data.

TAKEAWAY

• Patients residing more than 80 miles vs within 40 miles from an NCI-designated center were less likely to receive ARPIs (odds ratio [OR], 0.30; P = .002) or bone-targeting agents (OR, 0.46; P < .001) but more likely to undergo prostatectomy (OR, 1.97; P < .001).
• Patients living farther from a major cancer center initiated treatment faster (adjusted hazard ratio [aHR], 1.54; P < .001) and had a lower rate of metastasis (aHR, 0.58; P = .006). The authors speculated that those men may be diagnosed at later stages, precluding active surveillance, while their higher rate of surgery may partly explain the slower progression.
• Black patients had lower odds than White patients of receiving radiation therapy (OR, 0.45; P = .02) or bone-targeting agents (OR, 0.65; P = .02) and were less likely to undergo prostatectomy (OR, 0.65; P = .03).
• Black patients were less likely than White patients to undergo genomic analysis as part of the All of Us program, in line with prior studies of clinical testing. There were no differences in genomic testing according to income or education levels, however.

IN PRACTICE

“To our knowledge, we present the first evidence of an association between treatment usage and distance to an [NCI-designated comprehensive cancer center],” the study authors wrote, noting that the patterns are more complex than expected. The findings also highlight long-standing racial disparities, with the differences in bone agent use being “of critical importance,” given the generally higher risk for bone metastases in Black patients, they noted.

SOURCE

The study, led by Dhruv G. Pillai, National Cancer Institute, Bethesda, Maryland, was published online in JNCI Cancer Spectrum.

LIMITATIONS

The All of Us Research Program provided limited data on tumor grade and stage, which limited adjustment for disease severity. Missing electronic health record data likely contributed to underreporting of androgen deprivation therapy and chemotherapy use.

DISCLOSURES

The study was supported by the NCI’s Center for Cancer Research, National Institutes of Health Intramural Research Program. The authors disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.