Sociodemographic trends in prostate cancer: insights from the All of Us Research Program.
BACKGROUND: Prostate cancer disproportionately affects vulnerable populations. The All of Us Research Program (AoURP) is a database that aims to encapsulate the diversity of the United States. To explore the utility of this dataset in assessing prostate cancer disparities, we investigated whether treatment usage, disease progression, and genomic research participation vary across sociodemographic factors among AoURP participants with prostate cancer. METHODS: We identified AoURP participants with prostate cancer. Genomic research participation in AoURP, treatment usage, time-to-treatment, and time-to-metastasis were assessed by demographics and distance from a National Cancer Institute-designated comprehensive cancer center. Multivariable logistic regression and Cox proportional hazards regression were performed to evaluate treatment usage and time-to-treatment and time-to-metastasis, respectively. RESULTS: We observed lower genomic data availability in Black vs White patients (P < .001). In multivariable analyses, patients residing more than 80 miles from an NCI-designated comprehensive cancer center were less likely to receive androgen receptor pathway inhibitors (odds ratio [OR] = 0.30, 95% CI = 0.14 to 0.66; P = .002) and bone targeting agents (OR = 0.46, 95% CI = 0.30 to 0.70; P < .001) but more likely to undergo prostatectomy (OR = 1.97, 95% CI = 1.43 to 2.71; P < .001) than those residing less than 40 miles away. These patients also initiated treatment faster (hazard ratio [HR] = 1.54, 95% CI = 1.27 to 1.87; P < .001) and developed metastasis slower (HR = 0.58, 95% CI = 0.40 to 0.86; P = .006). Black patients were less likely to receive radiation (OR = 0.45, 95% CI = 0.23 to 0.88; P = .020), prostatectomy (OR = 0.65, 95% CI = 0.44 to 0.96; P = .028), and bone targeting agents (OR = 0.65, 95% CI = 0.45 to 0.93; P = .018) than White patients. CONCLUSIONS: Prostate cancer 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.