OBJECTIVES: It remains unknown whether the receipt of androgen deprivation therapy (ADT) and the related adverse outcomes differ by race. The objective of this study was to evaluate racial disparities in ADT and their impact on ADT-related adverse outcomes across population groups.

METHODS: This was a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset. Males with a primary diagnosis of metastatic prostate cancer who were aged 66 years or older between January 2010 and December 2017 were identified from the dataset. The ADT-related outcomes comprised of genitourinary complications, depression, ischemic and thrombotic events, and cardiovascular events. Competing risk regression models were used to determine the effects of race on ADT-related complications after controlling for a number of covariates.

RESULTS: Compared to non-Hispanic Caucasians, non-Hispanic African Americans had a lower incidence of genitourinary complications (Hazard ratio (HR) = 0.47, 95% CI: 0.23-0.98). In contrast, American Indians/Alaska Natives had a higher risk of genitourinary complications than non-Hispanic Caucasians (HR=7.28, 95% CI: 2.63-20.16). There were no significant differences in the incidence of genitourinary complications between non-Hispanic Caucasians and other races (i.e., Asians/Pacific Islanders and Hispanics). In addition, Asians/Pacific Islanders were less likely to experience depression (HR=0.49, 95% CI: 0.27-0.89) as well as ischemic and thrombotic events (HR=0.39, 95% CI: 0.17-0.88) than non-Hispanic Caucasians. No significant differences were observed in the incidence of depression as well as ischemic and thrombotic events between non-Hispanic Caucasians and other races (i.e., non-Hispanic African Americans, American Indians/Alaska Natives, and Hispanics). Regarding the incidence of cardiovascular events, there was no significant difference across race.

CONCLUSIONS: The study findings suggest that there existed racial disparities in incidence of ADT-related adverse events. Clinicians should pay attention to the population groups who are at greater risk for each ADT-related adverse outcome.