Exploring Differences in Androgen Deprivation Therapy Use for Prostate Cancer Between Black Men and White Men

Androgen deprivation therapy (ADT) is the standard treatment for metastatic hormone responsive prostate cancer (CaP), and when surgery or radiation is not an option for localized CaP. ADT is increasingly recommended as an adjuvant treatment with radiation therapy1 because of its survival benefit.2 ADT has also been shown to benefit men with metastatic disease. It can delay the onset of symptoms such as pain and fracture from bone metastasis, urinary obstruction, and bowel obstructions.3 ADT can be effective for two to three years in delaying the progression of CaP and its symptoms. Yet, it has been demonstrated that Black men are less likely to receive ADT compared to their White counterparts (OR=0.64).4-6 In a previous study using SEER-Medicare linked data, among men with locoregional CaP, Black men were significantly less likely (24%) to receive ADT than other White men.6 Furthermore, Cobran and colleagues (2018) found that Black men with metastatic CaP experienced significantly delayed receipt of ADT as compared to White men (172 days vs. 95 days, p<0.05).7 Additionally, others using SEER-Medicare data found that Black men with metastatic CaP were less likely to receive ADT, and when they did receive it, the treatment was delayed compared to other men.3,8 Despite the evidence supporting the benefit of ADT, in combination with radiation therapy, either adjuvantly or neoadjuvantly, to produce better outcomes,9 Black men are less likely to receive ADT with radiation therapy. Findings from a population-based study of men with locally advanced CaP showed that, even though radiation therapy combined with ADT is better than either alone, only 8% of Black men received radiation therapy plus ADT compared to 84% of other men.10 Therefore, the purpose of this convergent, mixed methods study is to explore provider and patient factors related to ADT receipt between Black and White men in a midwestern health system.