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Localized prostate cancer disparities in risk group at presentation and access to treatment for Hispanic men

Prostate Cancer and Prostatic Diseases volume 26, pages 309–316 (2023)Cite this article

Subjects

Abstract

Background

Despite great heterogeneity amongst Hispanic groups, prostate cancer studies often report Hispanic patients in aggregate. We sought to identify differences in prostate cancer risk group at presentation and treatment status among Hispanic subgroup populations.

Methods

Patients with localized prostate adenocarcinoma diagnosed from 2004–2017 were identified in the National Cancer Database (NCDB) and disaggregated by racial subgroup and Hispanic country of origin. Ordinal logistic regression defined adjusted odds ratios (AORs) with 95% CI of (1) presenting at progressively higher risk group and (2) receiving treatment with intermediate-unfavorable or high-risk disease.

Results

In our sample (n = 895,087), Hispanic men had greater odds of presenting with higher-risk localized prostate cancer compared with non-Hispanic White men (AOR = 1.18 95% CI 1.16–1.21, p < 0.001). Additionally, Hispanic Black men were less likely to present with higher-risk disease than non-Hispanic Black men. Disparities also existed when disaggregated by country of origin, particularly for Mexican men. Amongst men with unfavorable-risk disease, Hispanic men were less likely to receive treatment than non-Hispanic White men (95% CI 0.57–0.67, p < 0.001). The odds of Hispanic Black patients receiving treatment was 2.00 times the odds (95% CI 1.17–3.41 p = 0.011) of non-Hispanic Black patients receiving treatment. Upon disaggregation by country of origin, disparities persisted, particularly for Mexican men.

Conclusion

We found marked heterogeneity when risk group at presentation and treatment for higher-risk disease were disaggregated by racial subgroup and country of origin. Our findings support further collection of disaggregated data in Hispanic communities and study of potential mechanisms underlying the observed differences.

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Fig. 1: Differences in risk group at presentation among men with localized prostate cancer.
Fig. 2: Differences in treatment status among men with higher-risk localized prostate cancer.

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Data availability

The patient-deidentified National Cancer Database is available from the American College of Surgeons (https://www.facs.org/quality-programs/cancer/ncdb/puf) and is not owned by the authors of this work.

Code availability

Stata code is available upon request from the first and/or corresponding author.

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Funding

BAM is funded by the Prostate Cancer Foundation and (PCF), the American Society for Radiation Oncology (ASTRO), the Department of Defense, and the Sylvester Comprehensive Cancer Center. IF is funded in part through a Diversity Supplement from the Center to Reduce Cancer Health Disparities, National Cancer Institute, National Institutes of Health. KN has received funding from Tesaro, Pfizer, Boehringer, Ingelheim, GlaxoSmithKline UK Ltd, and Conquer Cancer Foundation outside the submitted work. ND has received funding from AstraZeneca, Merck, Pfizer, BMS, Genentech, BI Oncology, Janssen, and Neogenomics outside the submitted work. KY reported support from Flatiron Inc and Janssen R&D outside the submitted work. PLN reported receiving grants and personal fees from Bayer, Janssen, and Astellas and personal fees from Boston Scientific, Dendreon, Ferring, COTA, Blue Earth Diagnostics, and Augmenix outside the submitted work; PLN is also funded in part through the NIH Grant R01-CA240582. ECD is funded in part through the NIH/NCI Support Grant P30 CA008748.

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Authors and Affiliations

  1. University of Massachusetts Medical School, Worcester, MA, USA

    Nishwant Swami

  2. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Nishwant Swami

  3. Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA

    Yefri A. Baez

  4. Harvard Medical School, Boston, MA, USA

    Yefri A. Baez, Idalid Franco & Paul L. Nguyen

  5. Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA, USA

    Idalid Franco

  6. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Idalid Franco

  7. University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Fl, USA

    Tiffany Nguyen, Karthik Meiyappan, Minh Ton & Mohammed Alshalalfa

  8. Massachusetts Institute of Technology, Cambridge, MA, UK

    Bhav Jain

  9. Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, USA

    Crystal Seldon

  10. Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK

    Kenrick Ng

  11. UCL Cancer Institute, University College London, London, UK

    Kenrick Ng

  12. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Narjust Duma

  13. Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, Fl, USA

    Kosj Yamoah

  14. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Boston, MA, USA

    Paul L. Nguyen

  15. Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, Fl, USA

    Brandon A. Mahal

  16. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Edward Christopher Dee

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NS, ECD, and BAM had full access to all the data and had final responsibility for the decision to submit this article for publication. Concept and Design: All authors. Acquisition, analysis, interpretation of data: All authors. Drafting of the manuscript: NS, ECD, TN, and KM. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: NS and ECD.

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Correspondence to Brandon A. Mahal or Edward Christopher Dee.

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Swami, N., Baez, Y.A., Franco, I. et al. Localized prostate cancer disparities in risk group at presentation and access to treatment for Hispanic men. Prostate Cancer Prostatic Dis 26, 309–316 (2023). https://doi.org/10.1038/s41391-022-00526-5

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