Introduction: Metastatic prostate cancer (PCa) is highly lethal with a 5-year survival rate of 30%. Individuals with specific germline mutations, a family or personal cancer history, and/or identifying as Black/African-American display higher risk of developing PCa, including metastatic PCa. Healthcare barriers, such as lack of insurance and/or lower socioeconomic status, also correlate with advanced stage diagnosis. We sought to determine if the Area Deprivation Index (ADI), a ranking of socioeconomic disadvantage including income, education, employment, and housing quality, was associated with de novo metastases and/or metastatic progression in a racially/ethnically diverse VA PCa cohort. Methods: Veterans diagnosed and/or treated for PCa from 2000-2013 in the Greater Los Angeles VA Healthcare System were identified in accordance with an institutional review board approved protocol. Clinical, pathological, and demographic data were obtained from the electronic medical record and the Veterans Health Administration Corporate Data Warehouse. State ADI (decile rank of 1-10) was calculated based upon the 9-digit residential zip code. Multivariate analyses identified factors associated with de novo metastasis or metastatic progression. Kaplan-Meier (KM) analysis permitted survival comparison of de novo metastatic (M1) cases, or localized cases with metastatic progression (M0-MP). Results: Of 2152 PCa cases identified, ADI could be determined in 1498 (69.6%). There were 1311 M0, 76 M1, 136 MX cases, and 57 M0 patients who experienced metastatic progression (M0-P). On multivariate analysis, state ADI decile rank = 7 was significantly associated with de novo metastasis diagnosis (rank 7-8: OR=4.39 (1.26, 15.35); rank 9-10: OR=4.12 (1.05, 16.09)). State ADI rank was not associated with metastatic progression in M0 patients. There were no significant differences in PCa-specific survival by ADI Rank within M1 nor M0-P strata. Conclusions: Veterans residing in areas of high socioeconomic disadvantage (ADI rank =7) were > 4 times more likely to be diagnosed with de novo metastasis, while no effects of ADI were observed on PCa-survival in M1 cases or M0-P cases. These results suggest that even in a relatively equal access healthcare system, potential social barriers indicated by high ADI may lead to delayed diagnosis. Future studies linking frequency of healthcare visits and/or screening to ADI may reveal potential strategies to mitigate this disparity in the VA population. SOURCE OF Funding: Research support for the investigators include National Institutes of Health K08CA215312, KNM; 5P50CA092131, R01 PAR-20-077, IPG); US Department of Defense (W81XWH211075, IPG; W81XWH-19-1-0435, KY); Prostate Cancer Foundation (PCF17CHAL04, IPG; 20YOUNG02, KNM; 18VALO10, KY, NGN), Burroughs Wellcome Foundation (1017184, KNM); Basser Center for BRCA at the University of Pennsylvania (KNM); Jean Perkins Foundation (IPG), STOP Cancer Foundation (IPG), and VA ORD CSR&D (NGN).
