Abstract
Introduction
Numerous studies have shown that both race and insurance status may affect prostate
cancer (PCa) workup and treatment. Preliminary investigations have shown that these
factors may be associated with treatment delays, which may indicate inequitable care
and increase risk of tumor progression. This investigation aimed to assess whether
race and insurance impacted the interval between multiparametric MRI (mpMRI)-to-biopsy,
and biopsy-to-prostatectomy.
Materials and Methods
A single-institution analysis of 261 patients with recorded race and insurance data
was performed using an Institutional Review Board-compliant database with information
spanning from 2016 to 2022. Race was self-reported during intake, and insurance status
was retrieved from the electronic medical record. Insurance was sub-divided into private,
Medicare, and Medicaid. Diagnostic or treatment latency was defined as time between
mpMRI-to-biopsy, or biopsy-to-surgery.
Results
Stratified by race, there was no difference in either latency period when comparing
African American (AA) and white patients. Stratified by insurance status, there was
no difference in time from mpMRI-to-biopsy (P = .50), but there was a significantly longer interval from biopsy-to-prostatectomy
for patients with Medicaid insurance (P = .02). Patients with Medicaid waited on average 168 days to receive surgery, in
contrast to 92 days for private and 87 for Medicare. Notably, 82% of Medicaid patients
were AA.
Conclusion
Insurance status, which is inherently linked to race and social determinants of health,
portended a significantly increased interval between biopsy and surgery. Physicians
should be aware of the relationship between insurance status and treatment delay,
as well as its potential downstream consequences.
Keywords
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Article info
Publication history
Published online: December 30, 2022
Accepted:
December 28,
2022
Received in revised form:
December 24,
2022
Received:
September 15,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
