Evaluation of guideline recommended treatment utilization among Black and White men with metastatic prostate cancer.
Authors: Stein Jacob Newton , Deal Allison Mary , Winslow Hannah Clark , Morgan Katherine , Sholomon Ari Thomas , Whang Young E. , Charlot Marjory 
Published: September 2024

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Background:
Prostate cancer is the second leading cause of cancer death among men with a disproportionate burden on Black men.
1
Black men are twice as likely to die from prostate cancer compared to White counterparts.
2
Racial disparities in care delivery for early-stage disease are well documented and may contribute to disparate outcomes,
3–6
but less is known about racial gaps in advanced prostate cancer care, a stage where effective therapies can prolong life for years.
7
We sought to evaluate if treatment disparities were evident among Black and White men with metastatic prostate cancer.
Methods:
We performed a retrospective cohort study of patients with metastatic prostate cancer receiving treatment at a large public tertiary care health system between 2015 and 2020. Demographic, clinical, treatment, and medication prescribing data were extracted from the electronic health record. We excluded patients without ICD codes indicating metastatic disease, those without any documented medication data in our health system, and those who did not identify as Black or White race. We estimated the prevalence ratio (PR) of being prescribed each of the recommended treatment options for metastatic prostate cancer per National Comprehensive Care Network guidelines, including androgen deprivation therapy (ADT), novel anti-androgens, chemotherapy, and bone protection comparing Black men to White men using log-binomial regression.
Results:
We identified 1,594 patients with metastatic prostate cancer; 485 (30%) were Black. Black patients were younger and had higher Charlson scores compared to White men. Both groups were highly insured, Medicaid was more common for Black men (7.2% vs 2.2%). Prescribing of systemic treatments was similar by race (Table). Combination ADT and novel antiandrogen prescribing was also similar by race (PR 1.04 95% CI:(0.91 - 1.17), p=0.6). About 30% of both Black and White patients interacted with our Patient Navigation team, a group of oncology nurses focused on ensuring patients receive recommended care.
Conclusions:
In a large public tertiary care health system, we did not observe racial disparities in receipt of guideline recommended therapies for metastatic prostate cancer. High rates of insurance, a robust patient navigation program, and a well-developed pharmacy assistance program may have helped mitigate racial disparities in care. Ongoing analyses are evaluating prescribing patterns among patients with de novo metastatic disease. Future studies should explore delivery of prostate cancer therapies across health systems and the influence of patient navigation and pharmacy assistance programs on medication receipt.

Prevalence ratios of treatment by race.

Medication
PR (95% CI) for Black v White men
p-value

ADT
1.04 (0.98-1.11)
0.19

Novel Antiandrogen
1.05 (0.95-1.16)
0.31

Bone protection
0.89 (0.76-1.04)
0.13

Chemotherapy
1.09 (0.85-1.39)
0.51