OBJECTIVES: Study aim was to describe the variation of real-world treatment patterns by race among metastatic hormone sensitive prostate cancer (mHSPC) patients treated at five community cancer centers in the US.

METHODS: This retrospective study utilized de-identified electronic health records from the Cancer Treatment Centers of America and included patients with mHSPC who were treated with androgen deprivation therapy (ADT), docetaxel or novel androgen receptor inhibitors (nARIs) including combinations for at least 6 months between 1/2015-3/2021. Treatment patterns were observed among white and black race subgroups from first line of therapy (LoT) for mHSPC to metastatic castration-resistance, death, or lost-to-follow-up. LoT was defined as first to last date of active drug therapy, not including long-term hormone agonists.

RESULTS: Of 523 mHSPC pts (median follow-up 29.7 months), 315 (60%) were white and 171 (33%) were black. 65% had bone metastasis at mHSPC diagnosis and 75% had ECOG 0-1. Black patients were slightly younger (mean age 61 vs 63 years), predominantly from the South (70% vs 55%) and more commercially insured (64% vs 46%). Among white patients, LoT-1 was predominantly ADT monotherapy±FGARI (53%), followed by docetaxel (24%), abiraterone (16%) and enzalutamide (6%). LoT-1 was similar for black patients (ADT monotherapy±FGARI (53%), docetaxel (24%), abiraterone (16%) and enzalutamide (5%)). Of white patients, 46% received LoT-2 and 14% received LoT-3 versus 51% and 19% for black patients receiving LoT-2 and LoT-3, respectively. Abiraterone, enzalutamide, followed by docetaxel were the most commonly used treatments in LoT-2 and LoT-3 for both races.

CONCLUSIONS: Despite recommendations from guidelines on early intensification of therapy in mHSPC, we found that majority of black and white patients received either ADT alone or ± FGARI in LoT-1 while chemotherapy and nARIs were initiated in later lines. Within this predominantly commercial population, white and black patients exhibited similar treatment patterns, suggesting equitable access to oncology care.