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Racial and Ethnic Variation in Receipt and Intensity of Active Surveillance for Older Patients With Localized
Spyridon P Basourakos1,2, Anjile An3, Meenakshi Davuluri1
1Department of Urology, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
Urology Practice
|April 19, 2024
Summary
Active surveillance (AS) for prostate cancer is increasing, but racial disparities persist. Non-Hispanic Black men have lower AS utilization and less access to advanced tools like multiparametric MRI (mpMRI).
Area of Science:
- Oncology
- Health Services Research
- Health Disparities
Background:
- Active surveillance (AS) is increasingly used for prostate cancer management.
- Racial and ethnic disparities in AS implementation have been noted.
- The role of multiparametric MRI (mpMRI) in AS protocols is evolving.
Purpose of the Study:
- To investigate racial and ethnic differences in AS utilization for prostate cancer.
- To examine disparities in the intensity of AS, including mpMRI use.
- To focus on older men with low- and favorable intermediate-risk prostate cancer.
Main Methods:
- Utilized Surveillance, Epidemiology, and End Results (SEER) and Medicare data (2010-2017).
- Compared AS receipt by race/ethnicity using multivariable logistic regression.
- Assessed AS intensity (PSA tests, biopsy, mpMRI) using multivariable Poisson regression.
Main Results:
- AS use increased overall for low-risk prostate cancer (29.5% to 51.7%).
- Hispanic and non-Hispanic Black men were less likely to receive AS for low-risk disease.
- Non-Hispanic Black men had lower rates of mpMRI use in AS protocols for both low- and favorable intermediate-risk disease.
Conclusions:
- Despite increased AS adoption, significant racial disparities remain.
- Non-Hispanic Black men face lower AS utilization rates.
- Non-Hispanic Black men have reduced access to mpMRI within AS protocols, highlighting a technology gap.
