UPJ INSIGHT Racial and Ethnic Variation in Active Surveillance for Older Patients With Localized Prostate Cancer

By: Spyridon P. Basourakos, MD, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York; Anjile An, MPH, Weill Cornell Medicine, New York, New York; Meenakshi Davuluri, MD, MPH, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York; Laura C. Pinheiro, PhD, Weill Cornell Medicine, New York, New York; Bashir Al Hussein Al Awamlh, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Leonardo D. Borregales, MD, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York; Danny Luan, MD, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York; Rulla M. Tamimi, ScD, Weill Cornell Medicine, New York, New York; Jim C. Hu, MD, MPH, NewYork-Presbyterian Hospital-Weill Cornell Medicine, New York; Kevin H. Kensler, ScD, Weill Cornell Medicine, New York, New York | Posted on: 20 May 2024

Basourakos SP, An A, Davuluri M, et al. Racial and ethnic variation in receipt and intensity of active surveillance for older patients with localized prostate cancer. Urol Pract. 2024;11(3):538-546. doi:10.1097/UPJ.0000000000000529.

Study Need and Importance

Use of active surveillance (AS) for localized prostate cancer is increasing; however, racial and ethnic disparities have emerged in its implementation. Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we investigated differences by race and ethnicity in the utilization and composition of AS by race and ethnicity among older men with low- and favorable intermediate-risk prostate cancer in the US, with particular focus on the integration of multiparametric MRI into surveillance protocols.

What We Found

In our cohort of Medicare fee-for-service beneficiaries diagnosed with prostate cancer in 2010 to 2017, the proportion of men with low-risk tumors who underwent AS increased from 29.5% in 2010 to 51.7% in 2017, while the proportion among men with favorable intermediate-risk disease grew from 11.4% to 17.2% (Figure). Hispanic and non-Hispanic Black men with low-risk tumors were less likely to receive AS than non-Hispanic White men, while non-Hispanic Black men were more likely to receive AS for favorable intermediate disease. Non-Hispanic Black men receiving AS underwent prostate MRI at a lower rate compared to non-Hispanic White men, regardless of whether they had low-risk or favorable intermediate-risk disease.

Figure. Initial treatment course among 33,542 men age 66 or older and Medicare fee-for-service coverage diagnosed with prostate cancer between 2010 and 2017 by year of diagnosis for patients with low-risk prostate cancer (A), patient race and ethnicity for patients with low-risk prostate cancer (B), year of diagnosis for patients with favorable intermediate-risk prostate cancer (C), and patient race and ethnicity for patients favorable intermediate-risk prostate cancer (D).

Limitations

Receipt of AS was inferred through the absence of evidence of definitive treatment within the 2 years after diagnosis, potentially leading to misclassification. The cohort is limited to individuals with Medicare fee-for-service coverage and may have limited generalizability to younger patients or patients with Medicare Part C insurance.

Interpretation for Patient Care

The overall adoption of AS for older patients with localized prostate cancer continues to increase but remains below acceptable levels, particularly for those with low-risk tumors. However, disparities in AS use and composition, including lower usage of MRI, persist for Hispanic and non-Hispanic Black men. Eliminating these disparities is an important step toward advancing equity in prostate cancer outcomes.