Abstract C41: No difference in mortality between racial groups after prostate cancer diagnosis given equal access to health care
Authors: Hasan Afsheen , Kamel Mohamed , Davis Rodney , Su Joseph 
Published: March 2017

Abstract
Introduction: Prostate cancer (PCa) is the leading incident cancer and the second leading cause of cancer death among American men. African Americans (AAs) suffer a disproportionate burden of disease with 1.5 times higher incidence and more than double the mortality rates of European American (EA) men. AAs tend to be diagnosed with more virulent forms of the disease and at earlier ages than other racial/ethnic groups, which cannot be explained completely by differences in socioeconomic status or access to care. However, it is unclear whether there is significant difference in mortality between racial groups after PCa diagnosis (Dx) given equal access to health care. This study will evaluate if the mortality of AA is higher than other racial groups after PCa Dx using data from five Veterans Affairs (VA) medical facilities in the mid-south region.
Methods: A retrospective review of medical records from five VA hospitals in the mid-south was conducted. All prostate cancer patients diagnosed between January 2009 and December 2014 at these hospitals were included. Primary endpoint was overall survival. Vital status of patients was updated through December 2015. PCa patients were categorized into 3 categories of aggressiveness, i.e., high, intermediate, and low, based on clinical presentation at Dx, including Prostate-specific antigen (PSA) levels, Gleason Sum, and cancer stage. Multivariate Cox proportional hazard models were used to examine the risk of mortality after PCa Dx adjusting for age, marital status, tobacco history, alcohol history, PCa aggressiveness, and first course of treatment option with race as the primary predictive factor.
Results: After excluding 23 patients who did not report race, 11 pacific islanders, and 27 American Indian, Aleutian, Eskimo/Asian Indian, the dataset included 4,740 PCa patients of which, 2,327 patients were EAs and 2,413 were AAs. During this five year period, 545 deaths were reported, where 50.5% were EAs and 49.5% were AAs. As expected, high PCa aggressiveness vs. low/intermediate aggressiveness (Hazard Ratio (HR) = 1.33, 95% Confidence Interval (CI) = 1.08-1.63), distant metastasis at Dx (HR = 5.05, 95%CI = 3.81-6.71), and age (HR = 1.07, 95%CI = 1.06-1.07) were statistically significantly associated with mortality after PCa Dx. Using radiation therapy as reference, surgery as the first course of treatment (HR = 0.61, 95%CI = 0.45-0.82) was inversely associated with mortality after PCa Dx, while hormonal therapy and active surveillance were not significantly associated with mortality after PCa Dx. However, a non-statistically significant association was observed between AAs and mortality (HR=1.14, 95% CI=0.96-1.35, p = 0.14) when compared to EAs.
Conclusion: There was no significant difference between AAs and EAs in mortality after PCa Dx in this medical review of PCa patients in five VA hospitals in the mid-south. Although genetic, environmental, and lifestyle factors may contribute to the difference in PCa mortality observed between racial groups, AA race is not a significant contributor to death when given equal access to health care, such as in the VA hospital setting.
Citation Format: Afsheen Hasan, Mohamed Kamel, Rodney Davis, Joseph Su. No difference in mortality between racial groups after prostate cancer diagnosis given equal access to health care. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C41.