Racial differences in active surveillance intensity and overtreatment in men with prostate cancer.

Abstract

316 Background: Marginalized communities in cancer care are often characterized by lower healthcare utilization. In prostate cancer, however, utilization may have mixed effects on quality, particularly in the Medicare population where non-cancer health risks are more prevalent. In this context, we examined racial differences in active surveillance intensity (i.e. confirmatory testing) and potential overtreatment, two key measures of prostate cancer care quality. Methods: Using a 20% national sample of Traditional Medicare beneficiaries, we identified men with newly diagnosed prostate cancer from 2014 to 2019. We used multivariable logistic regression to evaluate the association between race (White, Black, or other) and receipt of a confirmatory test (prostate biopsy, magnetic resonance imaging, or genomic testing) within one year of diagnosis among men on active surveillance. We created a subset of patients with significant comorbidities to assess potential overtreatment (i.e., treatment among patients with >50% estimated non-cancer mortality in five years). Results: We identified 41,092 men meeting inclusion criteria. On adjusted analysis, Black men (OR=0.75; 95%CI: 0.62-0.92, p=0.01) had lower odds of receiving a confirmatory test compared to White men. Among men at risk of overtreatment, Black men (OR=0.86; 95%CI: 0.77-0.97, p=0.01) were less likely to receive treatment compared to White men. Further, all patients, regardless of race, had a predicted probability <50% of receiving a confirmatory test within one year of diagnosis (Table). Conclusions: Our study highlights racial differences in two measures of prostate cancer care, receipt of a confirmatory test and overtreatment. We demonstrated that Black men have lower odds of receiving a confirmatory test. This stands to disproportionately affect Black men, given that they present with higher risk tumors compared to other racial groups. Conversely, Black men have lower odds of being overtreated when compared with White men, suggesting that lower utilization may shield them from potential overtreatment and its related morbidity. As a result, policy efforts aiming to reduce disparities may be most impactful by prioritizing clinical contexts where utilization and access are tightly aligned with care quality. Predicted probabilities for confirmatory testing and overtreatment. White Black Other Confirmatory Testing 43% 37%* 46% Overtreatment 50% 43%* 46%* Adjusted for socioeconomic status tertile, Charlson Comorbidity Index, age, rurality, and year of diagnosis. *Indicates p<0.05.