Evaluating social vulnerability as a key determinant of definitive treatment for Black men with clinically localized prostate cancer.
Authors: Goodloe Jason Lloyd , Washington Samuel L , Wang Lufan , Cowan Janet E , Nguyen Hao , Carroll Peter , Chan June M. , Shariff-Marco Salma 
Published: February 2025

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Background:
Disparities in prostate cancer (PCa) outcomes have been documented extensively across different racial and ethnic groups and various social environments, yet interventions to address these concerns remain elusive. We aim to understand how race and social vulnerability influence the likelihood of definitive treatment for men diagnosed with non-metastatic PCa treated in community urology practices.
Methods:
Men diagnosed with clinically localized PCa in the CaPSURE registry were geocoded, deidentified, and combined with Social Vulnerability Index (SVI) data, a census-tract measure of communities' disadvantage, based on participants’ home address at enrollment. Patients were categorized by race [Black or non-Black (White, Hispanic, Asian, Mixed, Other, Unknown)] and SVI status (high/low): Black-high SVI, Black-low SVI, non-Black-high SVI, and non-Black-low SVI. The outcome was primary treatment: definitive (RP, RT) vs non-definitive (AS/WW). Multinominal logistic regression analysis assessed the association between SVI, race, and odds of definitive treatment, adjusted for age at diagnosis, education, income, insurance, comorbidities, BMI, smoking, alcohol use, year of diagnosis, clinical site, job type, and US Census subregion. Models were run separately for low and intermediate/high clinical PCa. A p-value <0.05 was statistically significant.
Results:
In total, 7854 men were identified with 714 (9%) Black and 3573 (45%) residing in high SVI communities; 72% of Black men had high SVI compared to 43% of Non-Black men (p<0.01). High risk disease was more common for Black men with high SVI compared to others (20% vs 9% for Black-low SVI vs 12% Non-Black high SVI vs 11% Non-Black low SVI, p<0.01). For low-risk disease, Black men with high SVI had lowest odds of definitive treatment compared to non-Black men with low SVI (OR 0.54, 95% CI 0.32-0.90); odds for other groups did not differ significantly. For intermediate/high risk disease, Black men with low SVI had the lowest odds of definitive treatment compared to non-Black men with low SVI (OR 0.24, 95% CI 0.10-0.56); odds for the other groups did not differ significantly.
Conclusions:
This study highlights the significant impact of social vulnerability on prostate cancer treatment outcomes among Black men, particularly those with high SVI, despite access to community urologic care. Black men with high SVI experiencing lower odds compared to their non-Black counterparts, even after adjustment for clinical risk, insurance coverage, comorbidities, geographic disparities, and age at diagnosis also contribute to treatment outcomes, emphasizing the intricate interplay of these factors. The unique combination of CaPSURE and SVI allows for the comprehensive assessment and geographic localization of multilevel drivers of treatment disparities which persist even in men receiving urologic care.