Racial Disparities in Clinical Trial Enrollment Among Patients Diagnosed With Prostate Cancer: A Population-Based Cohort of Oncology Practices.

Background: Although clinical trials should be accessible to all patients, persistent racial and ethnic disparities in clinical trial enrollment exist. Herein, we examine racial disparities in clinical trial enrollment among prostate cancer patients from a large population-based cohort of oncology practices in the United States. Methods: Using CancerLinQ Discovery, we identified men with regional (N1+) and/or metastatic (M1) prostate cancer diagnosed from 2011 to 2023. Enrollment into a clinical trial for prostate cancer was the primary outcome. Multivariable logistic regression and Cox proportional hazard regression were used for analysis. Results: Within our dataset, we identified 17,028 patients with advanced prostate cancer, of which only 2.6% of patients were enrolled in a clinical trial (n = 450). There was variance in the proportion of patients accrued over time with a low of 0.30% in 2011 to a high of 3.94% in 2018 and decreasing to 2.37% in 2023. On multivariable analysis, older age was associated with lower odds of clinical trial enrollment (p < 0.001). Compared to White patients, Hispanics/Latino (OR: 0.35; CI: 0.161-0.744, p=0.04) and patients with self-identified other race or ethnicity (OR: 0.23; CI: 0.295-0.931, p < 0.01) had lower odds of clinical trial enrollment on multivariable analysis. Black men with prostate cancer did not have a statistically significant difference compared to White men for clinical trial enrollment. (OR: 1.033; CI: 0.771-1.384, p=0.828). Conclusion: While clinical trial enrollment remains low for men with advanced prostate cancer in this contemporary population-based cohort, rates of participation for Hispanic/Latino men, but not Black men, are significantly lower. Increased attention is needed to better understand the reasons behind these racial disparities and to develop effective interventions to promote access.