Previous studies have shown that Black men receive worse prostate cancer care than White men. This has not been explored in metastatic castration-sensitive prostate cancer (mCSPC) in the current treatment era.
We evaluated treatment intensification (TI) and overall survival (OS) in Medicare (2015-2018) and Veterans Health Administration (VHA; 2015-2019) patients with mCSPC, classifying first-line mCSPC treatment as androgen deprivation therapy (ADT) + novel hormonal therapy; ADT + docetaxel; ADT + first-generation nonsteroidal antiandrogen; or ADT alone.
We analyzed 2226 Black and 16,071 White Medicare, and 1020 Black and 2364 White VHA patients. TI was significantly lower for Black vs White Medicare patients overall (adjusted odds ratio [OR] 0.68; 95% confidence interval [CI] 0.58-0.81) and without Medicaid (adjusted OR 0.70; 95% CI 0.57-0.87). Medicaid patients had less TI irrespective of race. OS was worse for Black vs White Medicare patients overall (adjusted hazard ratio [HR] 1.20; 95% CI 1.09-1.31) and without Medicaid (adjusted HR 1.13; 95% CI 1.01-1.27). OS was worse in Medicaid vs without Medicaid, with no significant OS difference between races. TI was significantly lower for Black vs White VHA patients (adjusted OR 0.75; 95% CI 0.61-0.92), with no significant OS difference between races.
Guideline-recommended TI was low for all patients with mCSPC, with less TI in Black patients in both Medicare and the VHA. Black race was associated with worse OS in Medicare but not the VHA. Medicaid patients had less TI and worse OS than those without Medicaid, suggesting poverty and race are associated with care and outcomes.
Prostate cancer and prostatic diseases. 2024 Apr 02 [Epub ahead of print]
Daniel J George, Neeraj Agarwal, Krishnan Ramaswamy, Zachary Klaassen, Rhonda L Bitting, David Russell, Rickard Sandin, Birol Emir, Hongbo Yang, Wei Song, Yilu Lin, Agnes Hong, Wei Gao, Stephen J Freedland
Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA. ., Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Pfizer Inc., New York, NY, USA., Department of Surgery, Medical College of Georgia at Augusta University, Georgia Cancer Center, Augusta, GA, USA., Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA., Pfizer AB, Sollentuna, Sweden., Analysis Group, Inc., Boston, MA, USA., Department of Health Policy and Management, Tulane University, New Orleans, LA, USA., Section of Urology, Durham VA Medical Center, Durham, NC, USA.