Investigating the Usage of Abiraterone in African American Men with Metastatic Prostate Cancer

Background: African American men bear an unequal proportion of metastatic prostate cancer burden. The utilization of second-generation anti-androgens like abiraterone with androgen deprivation therapy (ADT) has become a standard therapy for metastatic prostate cancer. Thus, we aimed to examine the utilization of abiraterone with ADT in African American men with metastatic disease and determine whether disparities in its use exist. Methods: This is a retrospective study, using a multi-institutional regional collaborative prostate cancer database. We compared the use of ADT with abiraterone between African American men and non-African American men diagnosed with distantly metastatic prostate cancer from July 2015 to August 2022, using logistic regression and negative binomial regression. Results: We identified 201 men with metastatic prostate cancer and of those, 28% were African American men. African American men were younger (47% vs. 27.8%, ≤ 69 years, p = 0.002), and younger men experienced a longer time between diagnosis of metastatic disease and receipt of ADT with abiraterone compared to older men (mean 125 vs. 14 days, p = 0.038). While African American and non-African American men had similar rates of ADT use with abiraterone, African American men experienced longer times between documented metastatic disease and initiation of ADT with abiraterone (mean 187 vs. 79 days, p = 0.042). Conclusion: The initiation of ADT with abiraterone was delayed by 3 months in African American men. This discrepancy warrants an investigation of system level barriers to the timely initiation of abiraterone in African American men given its known oncologic benefits.