Prostate cancer‐specific mortality burden by risk group among men with localized disease: Implications for research and clinical trial priorities

Abstract

ObjectiveTo estimate contemporary population‐based patterns of the relative burden of prostate cancer‐specific mortality (PCSM) attributable to each N0M0 prostate cancer risk‐group, that may guide prioritization in research, trial design, and clinical practice.MethodsWe categorized 2004‐2015 Surveillance, Epidemiology, and End Results database patients by risk group (low, favorable intermediate, unfavorable intermediate, high, and very highrisk). Using the Fine‐Gray method, we calculated the relative burden of 10‐year PCSM attributable to each risk group.ResultsAmong N = 337 162 men (6.8‐year median follow‐up; median age 65 years), the relative proportion of low‐, favorable intermediate‐, unfavorable intermediate‐, high‐, and very high‐risk diagnoses were 29.9% (N = 100 969), 31.1% (N = 104 696), 17.9% (N = 60 360), 18.1% (N = 61 023), and 3.0% (N = 10 114). Within 10 years of diagnosis, among patients who died of prostate cancer (N = 15 064), 5.0% (N = 746) had low‐risk, 13.7% (N = 2060) had favorable intermediate‐risk, 16.1% (N = 2429) had unfavorable intermediate‐risk, 47.8% (N = 7196) had high‐risk, and 17.5% (N = 2633) had very high‐risk disease at diagnosis. Patients aged 65 and older accounted for 51.9% of all diagnoses and 72.3% of 10‐year PCSM. Although black patients accounted for 15.0% of low‐risk diagnoses, they accounted for 20.6% of 10‐year PCSM. White patients accounted for 80.3% of low‐risk diagnoses and 75.7% of 10‐year PCSM.ConclusionAlthough high‐risk and very high‐risk disease account for one‐fifth of diagnoses, they account for two‐thirds of 10‐year PCSM. Older patients and black patients with low‐risk disease accounted for a disproportionately large proportion of deaths. These findings support targeting research toward high‐risk disease and ensuring adequate representation of older and black men in clinical trials.

Prostate Cancer Disparities in Risk Group at Presentation and Access to Treatment for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study With Disaggregated Ethnic Groups

“…Disparities in diagnosis, treatment, and mortality among men with PCa are extensively studied in the literature and tend to be associated with sociodemographic and genetic factors. [4][5][6][7] Of particular importance, race and ethnic group have been shown to influence PCa severity and treatment disparities. [7][8][9] These differences are likely mediated by a complex mix of tumor-specific and societal factors that map with race or ethnicity, including access to care, genomic ancestry, cultural preferences, and systemic barriers to care.…”

“…[4][5][6][7] Of particular importance, race and ethnic group have been shown to influence PCa severity and treatment disparities. [7][8][9] These differences are likely mediated by a complex mix of tumor-specific and societal factors that map with race or ethnicity, including access to care, genomic ancestry, cultural preferences, and systemic barriers to care. [4][5][6] Notably less is known about disparities in the risk group at presentation and subsequent treatment disparities among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) men with localized PCa.…”

In pursuit of equity in cancer care: Moving beyond the Affordable Care Act

“…For example, Black women with breast cancer are more likely to die from their cancer than are White women with breast cancer 18–20 . Compared with White men, Black men are more likely to be diagnosed with prostate cancer 21, 22 and—if in settings with unequal access to care—are more likely to die of prostate cancer 23–25 . These disparities are multifactorial in etiology and influence access and outcomes across the cancer care continuum, 18 from stage at presentation to disease‐specific outcomes 18–20, 25 .…”

“…[23][24][25] These disparities are multifactorial in etiology and influence access and outcomes across the cancer care continuum, 18 from stage at presentation to disease-specific outcomes. [18][19][20]25 It is a matter of ethical and moral weight to eliminate cancer disparities to promote justice in the opportunities people have to live as healthy lives as possible. 14 Cancer September 15, 2022 Some studies based on large databases have provided evidence that Medicaid expansion may reduce racial disparities in insurance coverage.…”

“…[18][19][20] Compared with White men, Black men are more likely to be diagnosed with prostate cancer 21,22 and-if in settings with unequal access to care-are more likely to die of prostate cancer. [23][24][25] These disparities are multifactorial in etiology and influence access and outcomes across the cancer care continuum, 18 from stage at presentation to disease-specific outcomes. [18][19][20]25 It is a matter of ethical and moral weight to eliminate cancer disparities to promote justice in the opportunities people have to live as healthy lives as possible.…”