Disparities in prostate cancer (PCa) outcomes after primary prostatectomy among Latinos.

Abstract

e17149 Background: PCa is the most frequently diagnosed malignancy among Latino men (Globocan, 2022). Latino patients with PCa experience a disproportionate disease burden with an overall higher lethality than non-Hispanic White men (NHW) (SEER, 2023). Historically, Latinos have been studied as a single group despite substantial inter-group heterogeneity, particularly in cancer care, which can result in misrepresentation in aggregated data (JCO OP, 2024). Methods: This study aimed to evaluate outcomes after radical prostatectomy among distinct Latino sub-populations treated at an NCI- comprehensive cancer center located in California. The City of Hope IRB-approved prostatectomy database was analyzed from 2003 to 2020 to identify Latino patients with PCa who had undergone a primary prostatectomy. Clinical and pathologic characteristics were collected. Latino patients were disaggregated and subcategorized as Mexican, South/Central American (SCA), or Caribbean (including Puerto Rico and Cuba). Patient groups were compared using χ², Fisher's exact, and Kruskal-Wallis rank sum test. Kaplan-Meier analysis was performed to estimate overall survival (OS). Patients without identified country origins were excluded from the survival analysis. Results: The dataset comprised 7084 patients, mostly NHW patients (N=5518, 78%), and 679 (10%) Latinos. Compared to NHW, Latino patients with PCa were younger at the time of surgery (62 vs. 64 years), had a higher BMI (28.8 vs. 27.5 kg/m²), higher PSA levels (6.2 vs. 5.5 ng/mL), and higher rates of D’Amico intermediate- (44 vs 42%) and high-risk disease (16 vs 14%) (all p < 0.001). Specifically, among the Latino patients, 304 (45%) were Mexican, 75 (11%) were SCA, 22 (3%) were Caribbean, and 223 (33%) were classified in the Spanish NOS subgroup. Mexican patients, compared to SCA and Caribbean patients, had higher PSA levels at diagnosis (6.7 vs. 6.1 vs 6.1 ng/mL, p=0.005) and longer operative times (188 vs. 176 vs. 173 minutes, p=0.02). By comparison, SCA men had fewer lymph nodes removed during surgery than Mexican and Caribbean (3 vs. 5 vs. 5, p<0.001). No significant differences were observed in age at surgery, BMI, prior treatments, estimated blood loss, D’Amico risk, Gleason scores, and pathologic staging. Survival analysis of 401 patients with an identified origin revealed shorter OS in Mexican patients than non-Mexican Latinos patients with PCa (SCA and Caribbean), with a 5-year OS rate of 97% vs. 99% and 10-year OS rate of 89% vs. 96% (p=0.017). Conclusions: We identified significant disparities among Latino patients with PCa following radical prostatectomy, with Mexican patients exhibiting higher PSA levels, requiring longer operative times, and experiencing notably shorter OS. These findings underscore the importance of future research that categorizes Latinos by subgroup to uncover the biological, lifestyle, and healthcare-related factors driving these disparities.