ASTRO 2021: Defining Racial Disparities Across the Prostate Cancer Disease Continuum in an Equal Access-to-Care Setting Within the Nation's Largest Healthcare Network

(UroToday.com) In a GU session at the American Society for Radiation Oncology (ASTRO) Annual Congress, Dr. Yamoah presented work defining racial disparities across the spectrum of prostate cancer in an equal access to care setting.

Dr. Yamoah began by emphasizing that racial disparities in prostate cancer are multi-dimensional and likely span the entirety of the disease continuum. A major component of these disparities relates to socioeconomic status and the access to care. However, these difference are unlikely to explain the increased incidence of prostate cancer among African American men.

Using the US Department of Veteran Affairs health care system which serves approximately 20 million veterans and provides equal access to health care, the authors defined a cohort of 92,269 men with localized prostate cancer with diagnosis between 2005 and 2015. Notably, despite similar screening access, African American men had a substantially higher risk of undergoing diagnostic biopsy.

In this cohort, there is a substantial higher rate of prostate cancer diagnosis among African American men, though substantial regional differences exist. Dr. Yamoah emphasized that the increased incidence of prostate cancer is a major driver of residual disparities in prostate cancer metastasis rates.

He emphasized that, among patients who were treated for prostate cancer outcomes were similar between European ancestry and African American men, even favouring African American men (HR 0.89, 95% CI 0.83 to 0.95). However, among those who did not receive radiotherapy or radical prostatectomy, survival was significantly worse for African American men (HR 1.29, 95% CI 1.17-1.42).

While equitable provision of treatment acts to equalize some of the disparities and improve outcomes for African American men, there are residual disparities in rates of de novo metastatic disease, and corresponding prostate cancer specific mortality that likely result due to the higher incidence of disease in African American men. Equitable provision of curative intent treatment (even when it is associated with differentially better outcomes in African American men) is unlikely to be able to address this disparities which are, therefore, likely to persist.

Further, these data highlight that while an equal access health care system may partial address institution specific disparities, the impact on population level disparity gaps remains relatively limited.

Written by: Christopher J.D. Wallis, University of Toronto Twitter: @WallisCJD during the 2021 American Society for Radiation Oncology (ASTRO) Hybrid Annual Meeting, Sat, Oct 23 – Wed, Oct 27, 2021.