Differences in prostate cancer treatment receipt and timeliness of treatment between African American/Black and White Iowans

TL;DR

Black men in Iowa are less likely to receive timely and definitive prostate cancer treatment compared to white men, even when treated at high-quality facilities.

Contribution

The study reveals racial disparities in treatment receipt for prostate cancer among Iowa residents, independent of facility quality.

Findings

Black men with advanced prostate cancer had significantly lower odds of receiving definitive treatment compared to white men.

Disparities in treatment persisted across all types of treatment facilities, including NCI-designated and CoC-accredited centers.

Black men were younger at diagnosis but still experienced reduced treatment access compared to white men.

Abstract

Non-Hispanic Black (NHB) men face higher prostate cancer (PCa) mortality rates compared to other racial/ethnic groups. Factors contributing to these disparities, particularly concerning healthcare system factors, remain uncertain. We investigate differences in treatment receipt and timeliness between NHB, non-Hispanic White (NHW) and Hispanic Iowans, examining variations across treatment facilities.

Demographic, tumor, treatment, and hospital characteristics of PCa patients 40–99 years were obtained from the Iowa Cancer Registry (2010–2020). We used logistic regression to estimate the odds of receiving definitive treatment, time to treatment, and the type of treatment received.

Among 18,747 PCa patients, 18,197 (97.1%) were NHW, 550 (2.9%) NHB, and 155 Hispanic (0.83%). NHB men were younger. The odds of receiving definitive treatment among advanced stage patients were significantly lower for NHBs compared to NHWs (adjusted odds ratio-AOR- 0.39; 95% CI 0.26—0.59). More NHBs underwent PCa treatment at either NCI-designated or CoC-accredited facilities. NHBs receiving care at an NCI-designated center or at a non-accredited center were less likely to receive definitive treatment compared to NHWs. Furthermore, NHBs with advanced PCa had diminished odds of receiving definitive treatment regardless of the status of the treatment facility (NCI: AOR = 0.34; 95% CI 0.13 – 0.93; CoC only: AOR = 0.47; 95% CI 0.29 – 0.76; Neither: AOR 0.24; 95% CI 0.10–0.60).

NHB men with an advanced staging had lower odds of receiving definitive treatment across treatment settings. Further research and intervention are needed to reduce these disparities and improve PCa outcomes.

The online version contains supplementary material available at 10.1007/s10552-025-02064-6.

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