OBJECTIVES: Prostate cancer (PCa) treatments, including radical prostatectomy (RP) and radiation therapy (RT), are associated with complications like urinary incontinence (UI) and erectile dysfunction (ED), which may require surgical care. This study investigated how median household income (MHI) influences the receipt of UI and/or ED surgical treatment in men post-prostate cancer treatment.

METHODS: Men with localized PCa who underwent RP and/or RT, and subsequently developed UI and/or ED from 2015-2021 were identified from the 100% Medicare Standard Analytical Files (SAF) and grouped into 4 cohorts: RP-ED (n=11,567), RT-ED (n=8,358), RP-UI (n=12,100), and RT-UI (n=5,329). County-level 2021 MHI data was extracted from the United States Census Bureau Small Area Income and Poverty Estimates dataset, cross-matched with SAF patient county codes, to classify patients into income quartiles (Q1: <$47,903, Q2: $47,903-$55,310, Q3: $55,311-$64,309, Q4: >$64,309). The incidence of surgical care (penile prosthesis for ED, artificial urinary sphincter or male sling for UI) per 100 person-years was calculated and compared between income groups using log-rank tests.

RESULTS: Incidence of surgical care was highest within the Q1 income quartile in all cohorts except RT-UI, where it was highest among Q2 patients. Log rank test of this difference was statistically significant only within the RP-ED cohort (RP-ED: 4.19 vs 2.58 vs 3.08 vs 3.05, p<0.05; RT-ED: 2.01 vs 1.74 vs 1.50 vs 1.40, p=0.17; RP-UI: 7.59 vs 6.50 vs 7.10 vs 6.95, p=0.62; RT-UI: 3.09 vs 4.13 vs 3.65 vs 3.52, p=0.47).

CONCLUSIONS: Interestingly, lower MHI was associated with higher rates of surgical care for post-PCa treatment complications. This could be attributable to more affluent patients accessing non-invasive treatment options not covered by Medicare in addition to increased access to UI and ED surgical treatments afforded by Medicare.