Impact of social environment on prostate cancer care across the clinical risk spectrum for Black men treated in community settings.

329 Background: Social environment impacts prostate cancer (PCa) care, particularly for Black men, but whether its effect remains constant across for the risk spectrum remains unclear. We aim to examine how social environment and race impact clinical risk-based treatment and metastasis-free survival (MFS) for Black individuals managed in community urology practices. Understanding these relationships may better inform community-based strategies to improve PCa care implementation. Methods: This observational cohort study evaluated individuals diagnosed with PCa from 1998 to 2022 across 38 community urology practices, academic centers, and VA hospitals. Participants included individuals with biopsy-proven, clinically localized PCa. Social environment was assessed using the census tract-level social vulnerability index, where rankings above the 75th percentile nationally was deemed “high vulnerability” communities. Risk-based treatment was defined as Radical Prostatectomy/Radiation Therapy (RP/RT) vs Active Surveillance/Watchful Waiting (AS/WW) or androgen deprivation therapy (ADT) for intermediate/high-risk PCa, and RP/RT/ AS/WW vs ADT for low-risk PCa. Multivariable logistic regression analysis examined associations between social environment, race, and risk-based treatment, adjusting for socio-demographics, comorbidities, and job status. Lifetable estimates, Kaplan-Meier curves, log-rank test, and Cox proportional hazards regression assessed associations between risk-based treatment and MFS for intermediate/high-risk PCa. Results: Among the 8,841 men identified, 863 (10%) were Black, 4,030 (46%) had low-risk PCa, and 1,064 (12%) had high vulnerability. Most (7988, 90%) were treated in community urology practices. Half (52%) underwent RP, 26% RT, 9% AS/WW, and 13% PADT. For low-risk PCa, Black individuals (OR 0.41, 95% CI 0.27-0.63) and those in high vulnerability communities (OR 0.50, 95% CI 0.34-0.72) had lower odds of risk-based treatment compared to ADT monotherapy. For those with intermediate/high-risk PCa, Black individuals (OR 0.37, 95% CI 0.28-0.49) was associated with lower odds of risk-based treatment while high community vulnerability was not. Those who received risk-based treatment had lower 10-year MFS compared to those who did not (95% vs 91%, log-rank p<0.01). After adjustment, risk-based treatment was associated with lower odds of metastasis (OR 0.70, 95% CI 0.52-0.94) compared to ADT or AS/WW. Conclusions: Relationships between social environment, race, and risk-based treatment change across the clinical risk spectrum for Black individuals with PCa. These findings underscore the importance of using clinical risk and social environment to inform community-based interventions to address inequities in risk-based treatment and outcomes for Black men with PCa.