Retrospective population-based cohort study of racial and ethnic differences in prostate cancer epidemiology across disease states in the VHA

Prostate cancer (PC) has evolved rapidly as a result of changes in PSA testing, novel imaging, and newer treatments. The impact of these changes on PC epidemiology are underexplored. In a cohort study of more than 6 million US veterans, Black patients had a greater than 2-fold higher risk of PC versus White patients across all disease states (nmHSPC, mHSPC, nmHSPC, and mCRPC). Disease progression risk varied by disease state and race and ethnicity, with Black and Hispanic patients having higher progression risks in early states but lower risks in later states. The authors conclude that dispite equal access in the Veterans Health Administration, racial and ethnic disparities persist in PC incidence and progression, highlighting the importance of evaluating these differences across the disease continuum to develop targeted strategies and improve outcomes.