Exploring social vulnerability in prostate cancer management: Insights into utilization of watchful waiting and active surveillance from 1998 to 2017.

Abstract

322 Background: Active surveillance (AS) and watchful waiting (WW) represent different conservative management strategies for prostate cancer (PCa), with AS being the preferred strategy. The Social Vulnerability Index (SVI) is enhancing our understanding of healthcare treatment disparities and social risk factors in the cancer care, but its impact in prostate cancer care remains unclear. We examine how social vulnerability influences the choice of WW vs AS in managing men with low and intermediate risk prostate cancer. Methods: The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database was used to identify men diagnosed with localized, low, and intermediate-risk prostate cancer (i.e., those potentially eligible for active surveillance) from 1998 to 2017. Participants' data were geocoded and de-identified, then combined with Social Vulnerability Index (SVI) data, which is based on four themes: socioeconomic status, household composition, minority status, and housing & transportation. We used multinomial logistic regression to examine the association between SVI and conservative management strategies of WW and AS. Results: Among 681 low-risk and intermediate-risk prostate cancer patients diagnosed from 1998 to 2017, 135 were assigned to watchful waiting (WW) and 546 to active surveillance (AS), reflecting a trend toward AS. The mean Social Vulnerability Index (SVI) was higher in the WW group (0.30) than in the AS group (0.21). Significant differences were noted by Socioeconomic Status (0.33 vs 0.15, p = 0.02). Conclusions: For patients with low and intermediate risk localized prostate cancer higher SVI, particularly in communities with greater socioeconomic challenges and higher proportion of racial while the overall proportion of AS increased over time. Our findings underscore how patients with higher SVI may experience considerable undertreatment, even with the concomitant increase in AS utilization over time. Identifying these communities remains a crucial step in addressing local drivers of treatment disparities in PCa care.