INTRODUCTION AND OBJECTIVE:
Various investigations have found higher prostate cancer mortality and morbidity based on race and socioeconomic status. Identifying social determinants of health is paramount in providing equitable, high-quality care to all patients. This study assesses the impact of race and insurance status on time from biopsy-to-multiparametric prostate MRI (mpMRI) and mpMRI-to-prostatectomy.
A single-institution review of all patients with recorded race and insurance status from 2016 to 2020 was conducted from an IRB-approved database. Race was defined as African American (AA) or White based on self-reporting. Latency was defined as days between most recent prostate MRI and biopsy or biopsy and surgery. Data was then analyzed using either unpaired t-test with Welch’s correction or one-way ANOVA, as appropriate for continuous variables, and Chi-Square test for categorical variables.
758 patients with recorded race (White n=438, AA n=310), and 122 patients with recorded insurance information were identified. The sample was then further stratified by presence of mpMRI, biopsy, or prostatectomy. There were no significant differences between race or insurance and biopsy/prostatectomy Gleason or PIRADS score, with the exception of AA race predicting higher biopsy Gleason score (χ2(4) =15.84, p<0.0032). Biopsy-to-mpMRI and mpMRI-to-surgery latency differed when stratified by race, although not statistically significant (Table 1). Increased latency for mpMRI-to-surgery for Medicaid patients was detected (Table 2).
Race did not confer any statistically significant differences in latency of either mpMRI-to-biopsy or biopsy-to-prostatectomy, although race was associated with increased biopsy Gleason score. While insurance status did not alter mpMRI-to-biopsy time, significantly longer latency was noted for biopsy-to-surgery for those with Medicaid. As high treatment latency can portend risk of adverse pathologic outcomes, further investigation into these results is needed to identify and address root causes.
Source of Funding: