Clinical and Sociodemographic Determinants of Treatment Selection in Prostate Cancer: A Population-Based Study in the United States (2004–2022)

Background: Prostate cancer remains one of the most prevalent malignancies and a leading cause of cancer-related mortality among men in the United States, with more than 300,000 new cases diagnosed annually. As the burden of disease continues to rise, ensuring equitable access to effective treatment remains a critical public health priority. Unequal access to definitive surgical management among disadvantaged populations may contribute to preventable morbidity and mortality. Radical prostatectomy is a cornerstone treatment for localized disease; however, its utilization has evolved over time in response to changing screening guidelines, technological advancements, and shifting treatment paradigms. Despite these developments, disparities in access to surgical management persist. Methods: Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective cohort study evaluating factors associated with radical prostatectomy utilization among 917,194 men with localized or regional prostate cancer diagnosed between 2004 and 2022. Multivariable logistic regression assessed demographic, socioeconomic, and clinical predictors of surgical treatment. Results: Overall, 33.5% of patients underwent radical prostatectomy. Increasing age was strongly associated with lower odds of surgery (OR 0.904 per year, 95% CI 0.903–0.904, p < 0.001), while married patients were significantly more likely to undergo prostatectomy (OR 1.601, 95% CI 1.554–1.649, p < 0.001). Black patients had markedly lower odds of surgery compared with White patients (OR 0.547, 95% CI 0.539–0.555, p < 0.001), whereas Asian/Pacific Islander patients had slightly higher odds (OR 1.082, p < 0.001). More recent year of diagnosis and increasing income were associated with modest reductions in prostatectomy utilization. Conclusions: These findings demonstrate that treatment selection in prostate cancer is influenced not only by disease characteristics but also by sociodemographic factors, highlighting persistent disparities in access to definitive surgical care and the need for targeted interventions to improve equity in treatment delivery.