Treatment disparities between heterosexual and gay and bisexual men diagnosed with prostate cancer.

[Darryl]

The following is part of next week's American Society of Clinical Oncology Annual meeting and was published in the Journal of Clinical Oncology. Malecare found significant treatment utilization disparities between heterosexual and MsM. Most startling is that almost twice as many initially treated heterosexuals navigate towards advanced stage treatment as do MsM.

Treatment disparities between heterosexual and gay and bisexual men diagnosed with prostate cancer.

Sub-category:

Advanced Disease

Category:

Genitourinary (Prostate) Cancer

Meeting:

2016 ASCO Annual Meeting

Abstract No:

e16548

Citation:

J Clin Oncol 34, 2016 (suppl; abstr e16548)

Author(s): Darryl Mitteldorf; Malecare Cancer Support, New York, NY

Abstract Disclosures

Abstract:

Background: Prostate Cancer treatment types are varied, with choice making conducted within the doctor-patient dyad. This study is the first to identify which treatments heterosexual and Gay and Bisexual men (MsM) choose throughout the disease progression spectrum. Methods: 780 men (632 = Heterosexual, 148 = MsM) completed an online survey during summer of 2015. The men were randomly selected from a national Prostate Cancer support network. We asked about treatments they used during the prior six months and most recently. Combination treatments were treated as a single variable. Results: In general, heterosexual men use more advanced-stage treatments than MsM, while MsM use more early-stage treatments than heterosexuals. For treatments used 6 months prior to survey: 1. Heterosexuals reported a mean of 1.27 advanced-stage treatments, while MsM reported a mean of 0.48 (difference = 0.79). 2. MsM reported a mean of 0.38 early-stage treatments, while heterosexuals reported a mean of 0.24 (difference = 0.14). For most recent treatments: 1. Heterosexuals reported a mean of 1.19 advanced-stage treatments, while MsM reported a mean of 0.54 (difference = 0.65). 2. MsM reported a mean of 0.87 early-stage treatments, while heterosexuals reported a mean of 0.56 (difference = 0.31). Heterosexuals used an average of .65 more treatments during the prior 6 months (p < .0001, 95% Confidence interval: [.38, .91]) and an average of 34 more recent treatments (p = .00013, 95% Confidence interval: [.17, .52]), than did MsM. Regarding the proportion of participants who took both early- and advanced-stage treatments in the last 6 months: Of heterosexuals who reported using early-stage treatments, 39% also reported taking one or more advanced-stage treatment, compared to only 21% for MsM (p < .05). Additional demographics (age, race, etc) and HRQoL questions were asked but provided no significance. Conclusions: We found significant treatment utilization disparities between heterosexual and MsM. Most startling is that almost twice as many initially treated heterosexuals navigate towards advanced stage treatment as do MsM.

[Tall_Allen]

I'm confused by the lack of stratification here. You are saying that:

(1) compared to straight men, gay men with early-stage disease (meaning low to intermediate risk?) are more likely to use early stage treatments (e.g. active surveillance, prostatectomy, radiotherapy monotherapies and focal treatments). (Did you count active surveillance as a treatment for early stage?)

(2) compared to straight men, gay men with advanced stage disease (e.g., meaning high risk, recurrent, metastatic and castrate-resistant?) are less likely to use therapies like combination radiation, salvage radiation, chemo, hormone therapy and immunotherapy. (Did you count watchful waiting as a treatment for late stage?)

Is that correct?

And is that because, having higher cure rates from their vigorous pursuit of early stage therapy, those who fail them give up trying the non-curative therapies? Were there any particular advanced-stage therapy (e.g., hormone therapies) that gay men were relatively averse to? Were there any particular early-stage therapy (e.g., active surveillance) that gay men were particularly prone to choose?

(typo: you meant .34 more treatments rather than 34)

[Darryl Partner in reply to Tall_Allen]

Ted, thank you for your questions. This is an abstract of focused research for a much longer article which points the way for more investigation along some of the lines you ask about.

[Tall_Allen in reply to Darryl]

I guess I'm asking some basic questions about the methodology of the study: what was the definition of "early stage" used in this study, and what treatments were counted as "early stage treatments"? What was the definition of "advanced stage" and what treatments were counted as "advanced stage treatments"?

[Darryl Partner in reply to Tall_Allen]

The methods description of the analysis currently runs about 9,000 words. I am still editing it. FYI This report did not reach a "conclusion" or deeper understanding of treatment types or therapies. It merely identified a disparity issue which we hope will lead the way to investigations and research towards a more practical understanding of prostate cancer.

[Tall_Allen in reply to Darryl]

Since I don't understand from the abstract what was measured and on whom, I guess I'll have to wait for the full text when it's done. I look forward to reading it then. I'm glad you're studying issues that impact gay men.