Examining the Impact of Race and Racial Concordance on Prostate Cancer Diagnostic Testing Rates Across a Large Integrated Delivery Network

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Publication Date

5-13-2024

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Presentation: 46:12

Abstract

Relatively few males die from prostate cancer (PCa) despite the high incidence. Black males disproportionately shoulder the mortality burden despite a lack of clinical evidence to justify it. The issue of overdiagnosis and overtreatment of PCa can lead to avoidable clinical and psychological consequences. Differences in clinical practice guidelines result in ambiguous options and leave room for delay and bias in clinical decisions. Also, evidence has shown that racial concordance between provider and patient leads to better health outcomes for minority patients. For these reasons, and because of the racial disparities seen in PCa across the cancer continuum, it is critical to systematically identify and achieve greater precision and personalization in the diagnosis of clinically significant PCa. The present study applied the Social-Ecological Model (SEM) to examine individual, interpersonal, and organizational factors that may explain any racial disparities present in the diagnostic testing of PCa. Data from Jefferson Health System was used, and logistic regression and hierarchical linear modeling were employed, to identify predictors of disparities in testing prevalence and type. Results showed that diagnostic tests are performed less frequently on Black males compared to White males despite a much higher PSA value for Black males prior to diagnostic testing. White males undergo more precise types of MRIs than Black males, but Black males undergo more precise types of biopsies than White males. More Black males who undergo systematic biopsies are MRI-naïve than White males. While no differences in testing were found in terms of racial concordance with urologist or site of care, both Black and White males benefit from greater testing rates when seen by HCPs who are doing comparatively more testing than their peers. These findings broadly demonstrate that there was less guideline-concordant diagnostic testing for Black males than for White males in this study.

Language

English

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