Introduction:

Prostate cancer is a major health concern, generating approximately 299,010 new cases annually and the second leading cause of cancer-related death among men in the US. Standard definitive treatments for prostate cancer including radical prostatectomy or radiation therapy offer the greatest long-term survival benefit. However, treatment decisions and oncologic outcomes post-treatment continue to be influenced by various non-clinical factors, such as individual’s socioeconomic status (SES) and community-level stressors and/or barriers to treatment. This study aims to explore the synergy between SES and SVI and their influence on treatment patterns and outcomes in men with intermediate and high-risk prostate cancer.

Methods:

A multicenter longitudinal cohort study was conducted involving men diagnosed with intermediate/high-risk prostate cancer who underwent definitive treatment with radical prostatectomy or radiation therapy. Data were sourced from the CaPSURE™ database, including patient demographics, clinical characteristics, treatment details, and SES indicators. Data for participants in the CaPSURE registry were geocoded, deidentified, and combined with publicly available Social Vulnerability Index (SVI) data. The survival analysis evaluated the relationship between SVI (overall and by themes) and failure or secondary treatment after RP or RT, using log-rank test. 

Results:

The cohort comprised 9,027 men, who were predominantly White (86.47%), Black (9.88%), and Asian/Latino/Other (3.65%), with a mean age at diagnosis of 65.5 years. 75.60% of high-SVI patients were Black, whereas 90.97% of the low-SVI group were White. Education levels varied, with 44.62% of high-SVI individuals having some high school education, while 43.35% of low-SVI individuals had college degrees. Correlation analysis between SES factors (education, income, insurance status) and SVI revealed weak associations. Education and income showed a moderate positive correlation (r=0.5251), while other correlations were weak, indicating no strong linear relationships. The log-rank tests indicated no significant differences in survival for overall SVI (χ² (1)=0.01, p=0.9216), Socioeconomic Status (Theme 1) (χ² (1)=0.10, p=0.7515), Household Composition & Disability (Theme 2) (χ²(1)=0.05, p= 0.8207), and Housing Type & Transportation (Theme 4) (χ²(1)=0.20, p=0.6576). Minority Status & Language (Theme 3) indicated a moderate correlation (χ² (1)=3.14, p=0.0764) to survival outcomes.

Conclusion:

The correlation analysis revealed weak associations between SES factors (insurance status, religious affiliation) and SVI, indicating that these factors do not have a strong overlap with social vulnerability and have largely independent effects on outcomes. Survival was not significantly affected by overall SVI, indicating that SVI and its themes largely impact treatment choice. For men who have overcome those barriers to definitive treatment, the outcomes are not different. These findings highlight the upstream impact of SVI on treatment outcomes, which is likely mediated through primary treatment selection which is an actionable endpoint for intervention within the urologists’ clinical context. Addressing community level vulnerability and patient-level SES factors to mitigate their independent influence on treatment selection will be critical to reducing disparities in oncologic outcomes for men receiving definitive prostate cancer treatment within the community setting. 

Funding: UCSF Prostate Cancer Program Pilot Research Award UCSF Goldberg-Benioff Program in Cancer Translational Biology Steven & Christine Burd Safeway Distinguished Professorship Goldberg-Benioff Endowed Professorship in Cancer Biology Movember Prostate Cancer Health Equity Grant