Clinical and demographic disparities in prostate cancer patients undergoing radical prostatectomy: A 20-year retrospective cohort study from the United States.

Abstract

205 Background: Radical prostatectomy remains a cornerstone treatment for localized prostate cancer. Understanding factors influencing surgical management is critical for addressing disparities in care delivery. This study examined demographic, clinical, and socioeconomic predictors of radical prostatectomy utilization using the national population-based cohort. Methods: We analyzed 1,259,662 male patients with a diagnosis of prostate cancer from SEERs database spanning 2000-2022. The primary outcome was receipt of radical prostatectomy (28.7% of cohort). Multivariable logistic regression was used to examine associations between surgical treatment and patient demographics (age, race/ethnicity, marital status), tumor characteristics (stage), socioeconomic factors (median household income), and treatment year. Missing data (1.2%) were excluded from analysis. Results: Among 1,244,064 patients with complete data, mean age was 67.1 years (SD 9.1). The cohort was 68.9% Non-Hispanic White, 14.1% Non-Hispanic Black, 9.6% Hispanic, and 5.1% Asian/Pacific Islander. Most had localized disease (62.5%), with 8.6% regional extension, 5.5% distant metastases, and 16.7% unstaged. In multivariable analysis, factors strongly associated with decreased surgical utilization included: 1. Advanced age (OR 0.89 per year, 95% CI 0.89-0.89, p<0.001). 2. Distant metastases (OR 0.10, 95% CI 0.09-0.11, p<0.001). 3. Unmarried status (OR 0.51, 95% CI 0.49-0.53, p<0.001). 4. More recent diagnosis year (OR 0.95 per year, 95% CI 0.95-0.95, p<0.001). Regional disease strongly predicted surgical management (OR 11.58, 95% CI 11.14-12.05, p<0.001). Married patients had 81% higher odds of surgery (OR 1.81, 95% CI 1.76-1.85, p<0.001). Higher income showed modest positive associations, with households earning >$100,000 having 14-28% higher odds compared to <$40,000. Racial disparities persisted after adjustment, with Non-Hispanic patients having lower surgical rates than Hispanic patients (OR 0.90, 95% CI 0.88-0.91, p<0.001). Conclusions: This large population-based study reveals significant disparities in radical prostatectomy utilization. The decline in surgical rates over time (5% decrease annually) may reflect evolving treatment paradigms and active surveillance adoption. Persistent disparities by race, marital status, and socioeconomic factors highlight the need for targeted interventions to ensure equitable access to surgical care. The strong influence of marital status suggests the importance of social support in treatment decision-making. Future research should examine whether these disparities impact oncologic outcomes and explore strategies to address modifiable barriers to surgical care.