SAN FRANCISCO-Age, race, income, and insurance status influence which men diagnosed with metastatic prostate cancer go untreated, according to a study reported at the Genitourinary Cancers Symposium (Abstract 101), a meeting co-sponsored by ASCO, ASTRO, and the Society of Urologic Oncology.
To determine what proportion of such patients go untreated and why, Alexander Small and colleagues at the Tisch Cancer Institute at Mount Sinai School of Medicine in New York City examined the National Cancer Database, which covers approximately 75% of new cancer diagnoses in the United States. Between 2000 and 2008, a total of 1,201,732 patients were diagnosed with prostate cancer and included in the database; 59,074 (4.9%) had metastatic prostate cancer. Of the men so diagnosed, a total of 6,582 (11.1%) received no anticancer therapy.
Older men were significantly less likely than younger men to receive therapy, such that the proportion of untreated men increased by 43% with each 10-year increase in age. Black men were 32% less likely than white men to receive therapy, whereas Hispanic men were 41% less likely.
Income and insurance status also had a statistically significant influence on whether patients received therapy. With every $10,000 increase in annual income, there was a 7% decrease in the proportion of men who went untreated. Compared with privately insured patients, men with Medicaid were 57% more likely to be untreated and men with Medicare were 82% more likely to go untreated. Men with no insurance were 96% more likely to go without anticancer therapy, compared with those who had private insurance.
The researchers concluded that while tumor biology likely plays a role with regard to rapid disease onset and progression, the results suggest that age, racial, and socioeconomic disparities exist in the treatment of metastatic prostate cancer.