New Study Shows Disparity in Prostate Cancer Treatment and Survival

Conceptual image for viral ethiology of prostate cancer. 3D illustration showing viruses infecting prostate gland which develops cancerous tumor: © Dr_Microbe - stock.adobe.com

Researchers found there to be racial disparities among patients with metastatic castration-sensitive prostate cancer (mCSPC) regarding treatment, survival, and access to care since the first novel hormonal therapy was approved in 2018.¹ Specifically, Black patients with mCSPC were less likely to be treated with novel treatments and were at a higher risk of death from their disease compared to White patients.

Findings come from a study published in the journal Prostate Cancer and Prostatic Diseases. The treatment intensification and overall survival (OS) of 18,297 Medicare and 3384 Veterans Health Administration (VHA) patients with mCSPC were evaluated. Experts sought to understand access to care and health outcomes by race and socioeconomic status.

Black patients with mCSPC were significantly less likely to receive treatment intensification compared with White patients. With Medicare, patients were 32% less likely while with VHA, they were 25% less likely. With Medicare, Black patients also had a 20% higher risk of death vs White patients. No significant differences in OS were observed between Black and White patients in the VHA population.

For all patients, overall treatment intensification rates were 10.3% for those in the Medicare group and 19.9% for those in the VHA group. Additionally, Medicare patients who were also enrolled in Medicaid were 33% less likely to get advanced treatments and had a 50% higher risk of death compared with those without Medicaid.

"Understanding the care of patients is critical to ensuring that treatments are made available to those who need them, regardless of race or socioeconomic status," said study investigator Hongbo Yang, a managing principal at Analysis Group, in a press release. "This study highlights a concerning disparity in emerging care for mCSPC, despite the availability of life-prolonging treatments."

Of those in the trial on Medicare, 2226 (12.2%) were Black and 16,071 (87.8%) were White, while 1020 (30.1%) Black patients and 2364 White (69.9%) were on VHA.

Black patients were younger than White patients in both the Medicare and VHA datasets (mean age, Medicare: 73.9 vs 76.9 years, standardized mean difference [SMD] –38.3%; VHA: 70.1 vs 74.4 years, SMD –45.2%). Black patients were also more likely to live in the South compared to White patients (Medicare: 55.0% vs 33.5%, SMD 44.4%; VHA: 38.5% vs 29.4%, SMD 19.3%).

There were some differences in health characteristics between Black and White patients:

• VHA only: Black patients were slightly more likely to have visceral metastasis and use pain medication.
• Both datasets: Black patients had a higher score on a modified Charlson Comorbidity Index.

Additionally,Black patients with VHA had higher median prostate-specific antigen, lower median hemoglobin, and similar median alkaline phosphatase levels vs White patients.

Treatment intensification was defined as patients receiving docetaxel; novel hormonal therapy consisting of abiraterone acetate (Zytiga), apalutamide (Erleada), or enzalutamide (Xtandi); or both, in addition to androgen deprivation therapy.

Overall, this study showed that treatment intensification in patients with mCSPC is slowly increasing. While evidence suggests this treatment improves OS and guidelines recommend its use, its overall adoption rate remains low. Moreover, Black patients were consistently less likely to receive treatment intensification vs White patients in both programs, and race was linked to OS in the Medicare population but not the VHA.

“Importantly, our study shows that Medicare patients who were Medicaid-enrolled received less [treatment intensification] and had worse OS in mCSPC. This suggests that poverty, in addition to race, is associated with quality of care and outcomes,” study authors wrote.²

REFERENCES:

1. Analysis group researchers identify racial disparities in treatment of metastatic castration-sensitive prostate cancer. News release. Researchers from Analysis Group. April 16, 2024. Accessed April 16, 2024. https://tinyurl.com/yc746bt8

2. George DJ, Agarwal N, Ramaswamy K, et al. Emerging racial disparities among Medicare beneficiaries and Veterans with metastatic castration-sensitive prostate cancer. Prostate Cancer Prostatic Dis. Published online April 2, 2024. doi:10.1038/s41391-024-00815-1