PD20-07 ASSOCIATIONS BETWEEN PATIENT SOCIODEMOGRAPHIC FACTORS AND RISK-APPROPRIATE PROSTATE CANCER MANAGEMENT

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD20-07 ASSOCIATIONS BETWEEN PATIENT SOCIODEMOGRAPHIC FACTORS AND RISK-APPROPRIATE PROSTATE CANCER MANAGEMENT Madison Novosel, Shayan Smani, Victoria Marks, Farah Jeong, Preston Sprenkle, and Michael Leapman Madison NovoselMadison Novosel More articles by this author , Shayan SmaniShayan Smani More articles by this author , Victoria MarksVictoria Marks More articles by this author , Farah JeongFarah Jeong More articles by this author , Preston SprenklePreston Sprenkle More articles by this author , and Michael LeapmanMichael Leapman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although definitive treatment is associated with improved survival for aggressive prostate cancer, a significant number of patients do not receive treatment. To identify gaps in practice, we sought to evaluate sociodemographic factors associated with non-treatment by clinical risk strata in the contemporary era. METHODS: We performed a retrospective study of patients with prostate cancer using the National Cancer Database. A total of 954,591 patients diagnosed with localized prostate (cT1-4N0M0) cancer from 2010 to 2020 were included in the analysis. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-treatment, stratifying analyses by D’Amico clinical risk criteria. RESULTS: The mean patient age at diagnosis was 65 years. Overall, 26.0% were diagnosed with low, 43.4% with intermediate, and 30.6% with high-risk prostate cancer. There were 131,122 (13.7%) who did not undergo initial treatment, including 82,318 (62.8%) with low, 35,499 (27.1%) with intermediate, and 13,305 (10.2%) with high-risk disease. The proportion of patients not receiving treatment increased over time in all risk groups between 2010 and 2010, including among low (11.7% versus 59.5%), intermediate (4.5% versus 12.5%) and high risk (3.6% versus 5.1%) disease. Compared with White patients, Black patients had lower odds of definitive treatment. This effect was more pronounced for patients with high (OR 0.61, 95% CI 0.58-0.64) rather than intermediate (OR 0.76, 95% CI 0.73-0.78) risk prostate cancer. Asian patients had lower odds of treatment compared with White patients across all disease risk strata (OR 0.84, 95% CI 0.80-0.88) but not high-risk disease (OR 0.90, 95% CI 0.80-1.00). There were lower odds of treatment among American Native/Alaskan Native versus White patients but not for high-risk disease (OR 0.79, 95% CI 0.57-1.10) Uninsured (OR 0.45, 95% CI 0.42-0.47, p<0.001), and Medicaid-insured (OR 0.68, 95% CI 0.66-0.71, p<0.001) patients were less likely to be treated overall. Patients residing in higher income areas had lower odds of over-treatment for low-risk prostate cancer (OR 0.84, 95% CI 0.81-0.87) and higher odds of treatment for high-risk prostate cancer (OR 1.34, 95% CI 1.25-1.44). CONCLUSIONS: Among patients diagnosed with prostate cancer in the contemporary era race and insurance are significantly associated with non-treatment for aggressive prostate cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e586 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madison Novosel More articles by this author Shayan Smani More articles by this author Victoria Marks More articles by this author Farah Jeong More articles by this author Preston Sprenkle More articles by this author Michael Leapman More articles by this author Expand All Advertisement PDF downloadLoading ...