Racial differences in delay of treatment for localized prostate cancer (CaP): A population-based study.

Abstract

6037 Background: African-Americans (AA) are diagnosed with more advanced CaP than Caucasians (CA) and are more likely to die from CaP. Treatment delay is a potentially modifiable obstacle to care and clinically may be more important in AA patients because of more aggressive cancer at diagnosis. We examined time from diagnosis to curative treatment (surgery or radiation) in AA and CA patients in the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database. Methods: 21,454 CA and 2,506 AA patients who were diagnosed with non-metastatic CaP from 2004-08 and received treatment within 12 months of diagnosis were included. Linear regression was used to examine factors associated with number of days from diagnosis to treatment initiation, and logistic regression to assess odds of treatment within 6 months of diagnosis. Results: AA patients were more likely to have high-risk CaP than CA patients (39 vs. 35%), and less likely to have low-risk CaP (27 vs. 31%) (p<.001). Time to treatment was significantly prolonged for AA patients in all risk groups of CaP, and the difference was most prominent for high-risk patients (median 105 days for AA vs. 96 days for CA, p=.002). Racial differences in time to treatment persisted in multivariable analysis (Table). Sensitivity analyses examining the proportion of AA and CA patients initiating treatment within 6 months of diagnosis revealed similar results. Conclusions: AA patients, especially those with high-risk CaP, experience longer treatment delays than CA patients. This is the first large-scale study to examine treatment delays in AA and CA patients with CaP. The differences found may contribute to our understanding of racial disparities in CaP treatment outcomes. [Table: see text]