Abstract 2265: Identifying disparities in prostate cancer treatment and genomic data availability utilizing the All of Us Research Program
Authors: Dhruv G. Pillai, Benjamin C. Brim, Nicholas G. Micheletti, Hyoyoung Choo-Wosoba, Laura M. Yee, Cindy H. Chau, William D. Figg
Journal: Cancer Research (2025)

Abstract The All of Us Research Program (AoURP) is a clinical and genomic database established by the National Institutes of Health that aims to encapsulate the diversity of the United States population. AoURP intends to enroll 1 million participants of diverse backgrounds through its robust outreach efforts, which selectively engage communities under-represented in biomedical research. AoURP may help elucidate disparities in prostate cancer (PCa) treatment and clinical research participation. This study aimed to explore whether PCa patients of various demographic backgrounds receive novel cancer treatments and participate in genomic research at different rates. To obtain a diverse cohort of participants, we identified every PCa patient in AoURP (n = 6271). We determined whether these patients opted for genetic testing by AoURP and extracted electronic health record data on commonly prescribed PCa treatments, including androgen deprivation therapy, second-generation anti-androgens, chemotherapy, prostatectomy, radiation, and bone-targeting agents. We stratified patients who obtained genetic testing and standard PCa treatments by demographic factors of household income, educational attainment, race, ethnicity, and distance from a National Cancer Institute (NCI)-designated comprehensive cancer center (NCIDCCC). To establish distance from an NCIDCCC as a categorical variable, we determined whether PCa patients resided within forty- and eighty-mile radii of one of these facilities. The study revealed that Black/African American patients received bone-targeting agents less frequently than their White/Caucasian counterparts. We also observed that more patients inside forty- and eighty-mile radii of an NCIDCCC obtained second-generation anti-androgens and bone-targeting agents than those outside these thresholds. Upon stratifying patients with history of prostatectomy or radiation based on additional thresholds (40, 50, 60, 70, 80, 90, and 100 miles), we found that more patients received prostatectomy than radiation at greater distances from NCIDCCCs. This result indicates that geographic factors may influence treatment of localized disease, with prostatectomy being more common for patients farther from major clinical centers. Additionally, we detected no variability in the rates at which different demographic groups underwent genetic testing. Overall, our study suggests that distance from an NCIDCCC and race may represent risk factors for treatment underuse in PCa patients, highlighting that additional outreach efforts by NCIDCCCs are necessary to encourage equitable usage of cancer treatments. Citation Format: Dhruv G. Pillai, Benjamin C. Brim, Nicholas G. Micheletti, Hyoyoung Choo-Wosoba, Laura M. Yee, Cindy H. Chau, William D. Figg. Identifying disparities in prostate cancer treatment and genomic data availability utilizing the All of Us Research Program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2265.