Introduction

The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races. We therefore sought to examine the variation in use of definitive therapy among Black and White men for localized PCa.

Methods

Using data from the National Cancer Data Base, we identified 283,135 White and Black men >=40years of age with biopsy confirmed localized intermediate-high risk PCa diagnosed between January 2004 and December 2013. Multilevel logistic regression was fitted to predict the odds of receiving definitive therapy for PCa. Sensitivity and subgroup analyses were performed to adjust for inherent patient and facility-level differences.

Results

82.9% (n=185,647) of White men received definitive therapy compared to 73.7% (n=43,662) of Black men over a 10-year period. Overall rates of definitive therapy during that time increased for both White (81.3% vs. 83.3%, p<0.001) and Black (72.8% vs. 75.4%, p=0.001) men. However, 38.5% of treating facilities demonstrated significantly higher rates of definitive therapy in White men, compared to just 0.8% of facilities favoring Black men.

Conclusions

After adjusting for sociodemographic and clinical factors, we found significant facility-level variation in rates of definitive therapy for intermediate-high risk localized PCa among White and Black men, with most facilities favoring therapy in Whites. Our study is limited by the retrospective nature of the cohort.

Funding

none