Associations between patient sociodemographic factors and non-treatment for localized prostate cancer.

307 Background: Although definitive treatment is associated with improved survival for aggressive prostate cancer, a significant number of patients do not receive treatment. To identify gaps in practice, we sought to evaluate sociodemographic factors associated with non-treatment by clinical risk strata in the contemporary era. Methods: We performed a retrospective study of patients with prostate cancer using the National Cancer Database. A total of 616,479 patients diagnosed with localized prostate (cT1-4N0M0) cancer from 2010 to 2017 were included in the analysis. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-treatment, stratifying analyses by D’Amico clinical risk criteria. Results: The mean patient age at diagnosis was 65 years. 29.0% were diagnosed with low, 43.7% with intermediate, and 28.4% with high-risk prostate cancer. There were 71,848 (11.7%) who did not undergo initial treatment, including 46,269 (64.4%) with low, 18,376 (25.6%) with intermediate, and 7,203 (10.0%) with high-risk disease. Overall, non-treatment increased for low-risk (11.6% versus 47.0%), intermediate (4.4% versus 9.7%) and high risk (3.4% versus 4.7%). Compared with White patients, Black patients had lower odds of definitive treatment. This effect was more pronounced for patients with high (OR 0.63, 95% CI 0.59-0.67) than intermediate (OR 0.78, 95% CI 0.75-0.82) risk disease. Asian patients had lower odds of treatment compared with White patients across all disease risk strata (OR 0.82, 95% CI 0.77-0.87). There were lower odds of treatment among American Native/Alaskan Native versus White patients with high-risk prostate cancer (OR 0.58, 95% CI 0.39-0.85). Uninsured (OR 0.41, 95% CI 0.39-0.44, p<0.001), and Medicaid-insured (OR 0.69, 95% CI 0.65-0.72, p<0.001) patients were significantly less likely to be treated overall. The effects of Black race and non-treatment did not differ by insurance status (p-value for interaction=0.237). Conclusions: Patient race and insurance are significantly associated with non-treatment for aggressive prostate cancer.