Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter

Abstract Objectives To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer among the various racial groups in the US exist, which may be a source of potential disparity in outcome. Methods Utilizing Surveillance, Epidemiology and End Results (SEER) -17, we identified 327,636 men diagnosed with prostate cancer from 2004-2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity. Results African-American and Hispanic men were less likely to receive treatment compared to White men (OR 0.73, 95% CI 0.71,0.75; and OR 0.95, 95% CI 0.92,0.98; respectively). African-American men had significantly lower odds ratio of receiving definitive treatment within each D'Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (Low risk OR 0.81, 95% CI 0.78,0.85; Intermediate risk OR 0.74, 95% CI 0.71,0.77; and High risk OR 0.62, 95% CI 0.58,0.66). Hispanic men with intermediate risk (OR 0.89, 95% CI 0.84,0.94) or high risk (OR 0.79, 95% CI 0.72,0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D'Amico classification. Conclusions There is a significant disparity in the receipt of treatment for prostate cancer among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer prostate cancer-related outcomes in these populations.