Socioeconomic Disparities in Prostate Cancer Treatment: The Impact of Area Deprivation Index on Initial Treatment Type for Localized PCa in a North-American Cohort

Background: Socioeconomic status and geographical location contribute to disparities in localized prostate cancer (PCa) treatment. We examined the impact of area of deprivation index (ADI) on initial treatment type for localized PCa in a North-American cohort. Methods: We performed a retrospective analysis of patients diagnosed with localized PCa, treated within Henry Ford Health (HFH), between 1995 and 2022, with available ADI-data. ADI was assigned based on residential census block group, ranked as a national deprivation percentile. Patients were categorized into three treatment-groups: radical prostatectomy (RP), radiation therapy (RT) and "other" treatment. Using multinomial logistic regression, we assessed ADI impact on treatment choice. After excluding patients without cT, ISUP-grade and/or PSA, we stratified by D'Amico risk-classification and repeated the regression analysis in each subgroup. Results: Among 14,204 patients, 28.4% were NHB. Median (IQR) age at diagnosis was 65 (59-71) years. Median (IQR) ADI was 58 (36-83) for overall cohort and 51 (30-74), 66 (45-91), and 62 (39-88) for RP, RT, and "other" groups, respectively (p < 0.0001). Multivariable analysis showed ADI as an independent predictor of treatment choice (p = 0.01): for each 10-unit increase in ADI, patients were 3% more likely to receive RT and 10% less likely to receive RP. High ADI predicted a lower likelihood of receiving initial surgery across all risk-groups (p < 0.001). Conclusions: Patients in more advantaged areas were more likely to receive RP, while those in disadvantaged areas received more RT. Recognizing how neighborhood factors affect treatment choices is crucial for improving health equity and reducing disparities in PCa outcomes.