Disparities in the Diagnosis and Management of Metastatic Prostate Cancer in Young Men
Less is known regarding younger men who are diagnosed with metastatic PCa, in whom disease trajectory and outcome may be distinct from older men. Therefore, we aimed to identify sociodemographic factors associated with the diagnosis of metastatic PCa in young men.
We queried the National Cancer Database to identify patients with PCa diagnosed in 2004-2014. We stratified patients by age ≤ 55 and examined clinic-demographic factors associated with the diagnosis of metastatic (M1 or N1) PCa. We used descriptive statistics to compare characteristics across strata, including initial treatment and utilization of palliative care services. We constructed multivariable logistic regression models to assess factors associated with metastatic vs. localized disease at presentation and treatment received.
We identified 186,578 men ≤55 diagnosed with PCa, including 9,888 with metastatic disease at presentation. In men ≤55, metastatic versus localized disease at diagnosis was associated with lack of insurance (OR 4.58 95% CI 4.23-4.96]), greater distance from facility (2.04 [1.18-3.51]), higher degree of comorbidity (1.66 [1.44-1.91]), treatment in academic setting (1.20 [1.15-1.26]), lower local education level (1.20 [1.09-1.31]), and lower income (1.15 [1.05-1.26]). African-American race was associated with metastatic disease in men >55 years, but not those younger than 55. Receipt of referral to palliative care in young men was associated with lack of insurance (OR 2.21 [95% CI 1.79-2.74]) or government insurance (1.84 [1.55-2.20]) compared to private, and treatment in community setting (1.34 [1.16-1.55]). Receipt of palliative care in older men had similar characteristics, but with additional factors of higher comorbidity index (OR 1.43 [95% CI 1.31-1.56]), lower income (1.37 [1.23-1.51]), and lower education level (1.27 [1.15-1.42]) (Table 1). Caucasian race (1.49 [95% CI 1.23-1.81]) and shorter distance to facility (0.04 [0.002-0.74]) were significantly associated with receipt of multi-agent chemotherapy for young men.
Among younger men with PCa, sociodemographic factors were significantly associated with the diagnosis of metastatic versus localized disease, as well as initial treatment or receipt of palliative care.
Funding: National Institute of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health