Background

Previous studies have shown that Black men receive worse prostate cancer care than White men. This has not been explored in metastatic castration-sensitive prostate cancer (mCSPC) in the current treatment era.

Methods

We evaluated treatment intensification (TI) and overall survival (OS) in Medicare (2015–2018) and Veterans Health Administration (VHA; 2015–2019) patients with mCSPC, classifying first-line mCSPC treatment as androgen deprivation therapy (ADT) + novel hormonal therapy; ADT + docetaxel; ADT + first-generation nonsteroidal antiandrogen; or ADT alone.

Results

We analyzed 2226 Black and 16,071 White Medicare, and 1020 Black and 2364 White VHA patients. TI was significantly lower for Black vs White Medicare patients overall (adjusted odds ratio [OR] 0.68; 95% confidence interval [CI] 0.58–0.81) and without Medicaid (adjusted OR 0.70; 95% CI 0.57–0.87). Medicaid patients had less TI irrespective of race. OS was worse for Black vs White Medicare patients overall (adjusted hazard ratio [HR] 1.20; 95% CI 1.09–1.31) and without Medicaid (adjusted HR 1.13; 95% CI 1.01–1.27). OS was worse in Medicaid vs without Medicaid, with no significant OS difference between races. TI was significantly lower for Black vs White VHA patients (adjusted OR 0.75; 95% CI 0.61–0.92), with no significant OS difference between races.

Conclusions

Guideline-recommended TI was low for all patients with mCSPC, with less TI in Black patients in both Medicare and the VHA. Black race was associated with worse OS in Medicare but not the VHA. Medicaid patients had less TI and worse OS than those without Medicaid, suggesting poverty and race are associated with care and outcomes.

中文翻译：

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医疗保险受益人和患有转移性去势敏感前列腺癌的退伍军人之间新出现的种族差异

背景

先前的研究表明，黑人男性比白人男性接受的前列腺癌护理更差。在当前的治疗时代，尚未在转移性去势敏感型前列腺癌（mCSPC）中对此进行探索。

方法

我们评估了 Medicare（2015-2018 年）和退伍军人健康管理局（VHA；2015-2019 年） mCSPC 患者的治疗强化（TI）和总生存期（OS），将一线 mCSPC 治疗分类为雄激素剥夺疗法（ADT）+新型疗法荷尔蒙疗法； ADT+多西他赛； ADT+第一代非甾体抗雄激素；或单独使用 ADT。

结果

我们分析了 2226 名黑人和 16,071 名白人医疗保险患者，以及 1020 名黑人和 2364 名白人 VHA 患者。总体而言，黑人医疗保险患者与白人医疗保险患者（调整后比值比 [OR] 0.68；95% 置信区间 [CI] 0.58–0.81）和无医疗补助患者（调整后 OR 0.70；95% CI 0.57–0.87）相比，TI 显着较低。无论种族如何，医疗补助患者的 TI 均较少。总体而言，黑人医疗保险患者与白人医疗保险患者（调整后风险比 [HR] 1.20；95% CI 1.09–1.31）和无医疗补助患者（调整后 HR 1.13；95% CI 1.01–1.27）的 OS 较差。有医疗补助的 OS 比没有医疗补助的 OS 更差，种族之间的 OS 没有显着差异。黑人 VHA 患者的 TI 明显低于白人 VHA 患者（调整后 OR 0.75；95% CI 0.61–0.92），种族间 OS 没有显着差异。

结论

对于所有 mCSPC 患者，指南建议的 TI 较低，而 Medicare 和 VHA 中黑人患者的 TI 较低。黑人种族与医疗保险中较差的 OS 相关，但与 VHA 无关。与没有医疗补助的患者相比，医疗补助患者的 TI 更少，OS 更差，这表明贫困和种族与护理和结果相关。