Racial differences in receipt of guideline-recommended treatment in men with low-, intermediate-, and high-risk prostate cancer (CaP): A population-based study.

Abstract

9002 Background: Compared to Caucasian men, African American (AA) men are more likely to develop more advanced disease and die from CaP. The recent incorporation of Gleason score and prostate-specific antigen (PSA) into Surveillance, Epidemiologic and End Results (SEER) allows examination of guideline-recommended treatment selection as a modifiable factor of the CaP mortality outcome disparity. Methods: 12,197 Caucasian and 2,362 AA men diagnosed in 2004-5 with localized CaP, age 65 or older, were drawn from SEER registries with at least 5% of AA population. Gleason, PSA and clinical stage were used for risk-categorization. Medicare claims data were used to determine initial treatment received. The National Comprehensive Cancer Network (NCCN) guidelines were used to determine if patients received recommended treatment. Fisher's exact test was used to determine statistical significance. Logistic regression was used to examine the odds of receiving NCCN treatment while accounting for risk group, age, comorbidity, marital status, and SEER region. Results: In stratified analysis, 77-81% of Caucasian and AA men with low- and intermediate-risk CaP received NCCN treatments. Among high-risk patients, AA vs. Caucasian men were less likely to receive NCCN treatments (39% vs. 46%, p<.01), including 29% who received no treatment within 8 months of diagnosis (vs. 20% Caucasian) and 29% hormonal treatment only (vs. 26% Caucasian). Racial differences in receipt of guideline-recommended treatment persisted in multivariable modeling for the entire cohort (Table). Conclusions: AA men are less likely to receive guideline-recommended treatment, especially those with high-risk CaP. The differences in the proportion of patients receiving recommended therapy may contribute to our understanding of racial disparities in CaP treatment outcomes. Covariate OR 95% CI P value AA (vs. Caucasian) 0.80 0.72, 0.88 <0.01 Risk group (vs. low risk) Intermediate 0.94 0.83, 1.06 0.29 High 0.23 0.20, 0.25 <0.01 Age (vs. 65-69) 70-74 0.89 0.80, 0.99 0.03 <75 0.41 0.38, 0.46 <0.01 NCI combined index score (comorbidity) 0.74 0.68, 0.80 <0.01 Married (vs. not) 1.30 1.19, 1.42 <0.01 Controls for SEER region. No significant financial relationships to disclose.