Indigenous Peoples have higher morbidity rates and lower life expectancies than non-Indigenous Canadians. Identification of disparities between Indigenous and non-Indigenous men regarding prostate cancer (PCa) screening, diagnoses, management, and outcomes was sought.
An observational cohort of men diagnosed with PCa between June 2014 and October 2022 was studied. Men were prospectively enrolled in the province-wide Alberta Prostate Cancer Research Initiative. The primary outcomes were tumor characteristics (stage, grade, and prostate-specific antigen [PSA]) at diagnosis. Secondary outcomes were PSA testing rates, time from diagnosis to treatment, treatment modality, and metastasis-free, cancer-specific, and overall survivals.
Examination of 1,444,974 men for whom aggregate PSA testing data were available was performed. Men in Indigenous communities were less likely to have PSA testing performed than men outside of Indigenous communities (32 vs. 46 PSA tests per 100 men [aged 50-70 years] within 1 year; p < .001). Among 6049 men diagnosed with PCa, Indigenous men had higher risk disease characteristics: a higher proportion of Indigenous men had PSA ≥ 10 ng/mL (48% vs. 30%; p < .01), TNM stage ≥ T2 (65% vs. 47%; p < .01), and Gleason grade group ≥ 2 (79% vs. 64%; p < .01) compared to non-Indigenous men. With a median follow-up of 40 months (interquartile range, 25-65 months), Indigenous men were at higher risk of developing PCa metastases (hazard ratio, 2.3; 95% CI, 1.2-4.2; p < .01) than non-Indigenous men.
Despite receiving care in a universal health care system, Indigenous men were less likely to receive PSA testing and more likely to be diagnosed with aggressive tumors and develop PCa metastases than non-Indigenous men.
Cancer. 2023 Jul 10 [Epub ahead of print]
Alex Kiciak, Wayne Clark, Maxwell Uhlich, Angeline Letendre, Randy Littlechild, Patrick Lightning, Catalina Vasquez, Raja Singh, Stacey Broomfield, Anais Medina Martin, Guocheng Huang, Adrian Fairey, Michael Kolinsky, Christopher J D Wallis, Christopher Fung, Eric Hyndman, Steven Yip, Tarek A Bismar, John Lewis, Sunita Ghosh, Adam Kinnaird
Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada., Indigenous Health Initiatives, University of Alberta, Edmonton, Alberta, Canada., Alberta Prostate Cancer Research Initiative, Edmonton, Alberta, Canada., Cancer Prevention and Screening Innovations, Alberta Health Services, Edmonton, Alberta, Canada., Maskwacis Health Services, Maskwacis, Alberta, Canada., Division of Urology, Department of Surgery, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada., Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.