Sociodemographic trends in prostate cancer: Insights from the all of Us research program

Abstract Background Prostate cancer (PCa) disproportionately affects vulnerable populations. The All of Us Research Program (AoURP) is a database that aims to encapsulate the diversity of the U.S. To explore the utility of this dataset in assessing PCa disparities, we investigated whether treatment usage, disease progression, and genomic research participation vary across sociodemographic factors among AoURP participants with PCa. Methods We identified AoURP participants with PCa. Genomic research participation in AoURP, treatment usage, time-to-treatment (TTT), and time-to-metastasis (TTM) were assessed by demographics and distance from a National Cancer Institute-designated comprehensive cancer center (NCIDCCC). Multivariable logistic regression and Cox proportional hazards regression were performed to evaluate treatment usage and TTT and TTM, respectively. Results We observed lower genomic data availability in Black versus White patients (p < 0.001). In multivariable analyses, patients residing >80 miles from an NCIDCCC were less likely to receive ARPIs (OR = 0.30, 95% CI 0.14–0.66, p=.002) and BTAs (OR = 0.46, 95% CI 0.30–0.70, p<.001) but more likely to undergo prostatectomy (OR = 1.97, 95% CI 1.43–2.71, p<.001) than those <40 miles. These patients also initiated treatment faster (HR = 1.54, 95% CI 1.27–1.87, p<.001) and developed metastasis slower (HR = 0.58, 95% CI 0.40–0.86, p=.006). Black patients were less likely to receive radiation (OR = 0.45, 95% CI 0.23–0.88, p=.020), prostatectomy (OR = 0.65, 95% CI 0.44–0.96, p=.028), and BTAs (OR = 0.65, 95% CI 0.45–0.93, p=.018) than White patients. Conclusions PCa treatment usage, disease progression, and genomic research participation varied between demographic populations. As AoURP matures, additional studies may leverage future data releases to confirm these findings.