Association of area of deprivation index with Active Surveillance (AS) oncological outcomes: Results from a contemporary north American cohort
Recommended Citation
Bertini A, Cirulli GO, Stephens A, Tylecki A, Finocchiaro A, Vigano S, Cusmano NB, Dinesh A, Robinson B, Mssika A, Guivatchian E, Lughezzani G, Buffi N, Di Trapani E, Ficarra V, Salonia A, Briganti A, Montorsi F, Sood A, Rogers C, Abdollah F. Association of area of deprivation index with Active Surveillance (AS) oncological outcomes: Results from a contemporary north American cohort. Eur Urol 2025; 87(S1):830.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Eur Urol
Abstract
Introduction & Objectives: Active Surveillance (AS) for Prostate Cancer (PCa) requires regular follow-up, raising concerns that socioeconomic barriers may result in improper AS utilization and consequently worse oncological outcomes. We examined the relationship between socioeconomic factors, measured by the Area Deprivation Index (ADI), and AS oncological outcomes in a contemporary North American cohort. Materials & Methods: We included all the patients aged < 75 years and diagnosed with low (ISUP GG = 1, PSA < 10 ng/ml and cT1N0M0) and intermediate risk (ISUP GG = 2, PSA 10-20 ng/ml or cT2N0M0) PCa, who received AS at Henry Ford Health (HFH) between 1995 and 2023. Only patients who received at least 1 PSA or 1 prostate biopsy without any active treatment for at least 1 year after diagnosis were considered under AS. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. The higher the ADI, the more the area has a socio-economic disadvantage. Cox regression analysis tested the impact of ADI on the risk of upgrading, active treatment, metastasis and Prostate Cancer Specific Mortality (PCSM). Due to the small number of events, only UVA was performed for metastasis and PCSM risk. Results: Our final cohort consisted of 901 patients who underwent AS, 328 (36%) of whom were in Non-Hispanic Black (NHB). Median (IQR) age was 66 (61-70) years. Patients in the most disadvantage quartile (Q4) were more likely to be NHB (65.7% vs 13.7%, p<0.0001), had higher probability to have CCI > 2 (49.8 % vs 32.5%, p=0.0003), higher median Prostate Specific Antigen (PSA) values (5.6 vs 4.7 ng/mL, p=0.0001), Gleason score (GS) 3+4 (28.6 % vs 13.7%, p<0.0001), and intermediate risk PCa (40% vs 26.5%, p<0.0001) at diagnostic presentation, compared to the ones in the least disadvantaged quartile (Q1). Moreover, patients living the most disadvantaged areas (Q4) were more likely to receive active treatment (36.5% vs 31.6 %, p=0.03) and to undergo radiotherapy (RT) (18.4% vs 8.5%, p=0.03), compared to those livigng in the least deprived neighboorhoods (Q1). At regression analysis, no significant association between ADI score and risk of upgrading (p=0.08), active treatment (p=0.08), metastasis (p=0.2) and PCSM (p=0.1) was detected. When compared to NHW men, NHB men had a 1.37 (95% CI, 1.08-1.75) higher probability of receiving active treatment (p=0.01). Conclusions: Our findings indicate that, despite having more adverse features at presentation, patients from socioeconomically disadvantaged did not show worse oncological outcomes for AS. Coversely, NHB men were more likely to receive active treatment.
Volume
87
Issue
S1
First Page
830
