Socioeconomic Disparities in Prostate Cancer Treatment: The Impact of Area Deprivation Index on Initial Treatment Type for Localized Prostate Cancer in a North American Statewide Cohort

Introduction: – Socioeconomic status and geographical location contribute to disparities in localized prostate cancer (PCa) treatment. We examined the impact of Area of Deprivation Index (ADI) on initial treatment type for localized PCa in a North American cohort.Methods: – We performed a retrospective analysis of patients diagnosed with localized PCa treated within the state of Michigan between 2010 and 2022 with available ADI data. The latter was assigned based on the residential census block group, ranked as a national deprivation percentile. Patients were categorized into 3 treatment groups: radical prostatectomy (RP), radiation therapy (RT), and Other treatment. Using multinominal logistic regression, we assessed ADI impact on treatment choice. After excluding patients without cT, International Society of Urological Pathology grade, and/or PSA, we stratified by D'Amico risk classification and repeated the regression analysis in each subgroup.Results: – The cohort consisted of 46, 481 patients. Among those, 17.7% were non-Hispanic Black men. Regarding treatment, 21, 152 (45.51%) patients underwent RP, 9713 (20.89%) received RT, and the remaining 15, 616 (33.59%) underwent Other treatments. Median (IQR) national ADI percentile was 58 (38-79), and it was 55 (37-76), 62 (41-83), and 59 (38-82) for the patients treated with RP, RT, and Other, respectively (P < .0001). At multivariable analysis, ADI was significantly associated with the type of received treatment. For each 10-unit increase in ADI, patients were 3% more likely to receive RT and 2% less likely to receive an RP, compared with Other treatment (odds ratio [OR], 1.03, 95% CI, 1.02-1.04; P < .001 and OR, 0.98, 95% CI, 0.97-0.99; P < .001, respectively). When stratified by D’Amico risk classification, among patients with known PSA, grade, and stage (25, 571 patients), 6976 (27.28%) were low risk, 12, 329 (48.21%) were intermediate risk, and 6266 (24.50%) were high risk. At multivariable analysis, for each 10-unit increase in ADI percentile, low-risk patients were 7% more likely to receive RT compared with other treatments (OR, 1.07, 95% CI, 1.04-1.10; P < .001). Although among intermediate-risk and high-risk patients with PCa, each 10-unit increase in ADI was associated with 4% and 6% decreased likelihood of receiving RP, respectively, compared with other treatments (OR, 0.96, 95% CI, 0.95-0.98; P = .001 and OR, 0.94, 95% CI, 0.91-0.97; P <.001).Conclusions: – Patients living in developed areas were more likely to receive RP, while those living in the most disadvantaged areas received higher rates of RT. Understanding neighborhood influence on initial localized PCa treatment is essential in guiding interventions and reducing disparities.