Structural inequities in the availability of prostate cancer clinical trial opportunities

Rishi Robert Sekar; Laura Zebib; Kristian Donald Stensland; Lindsey Allison Herrel

doi:10.1093/jnci/djaf047

Structural inequities in the availability of prostate cancer clinical trial opportunities

J Natl Cancer Inst. 2025 Feb 26:djaf047. doi: 10.1093/jnci/djaf047. Online ahead of print.

Authors

Rishi Robert Sekar^{1

2

3}, Laura Zebib⁴, Kristian Donald Stensland^{1

2}, Lindsey Allison Herrel^{1

2}

Affiliations

¹ Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
² Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
³ National Clinician Scholars Program.
⁴ Department of Urology, University of California San Franciso, San Francisco, California, USA.

PMID: 40036373
DOI: 10.1093/jnci/djaf047

Abstract

Prostate cancer is marked by vast disparities in clinical outcomes for minoritized and socioeconomically disadvantaged populations. We aimed to evaluate the geographic distribution of prostate cancer clinical trial opportunities relative to prostate cancer mortality and social determinants of health by performing an ecological analysis of linked county-level prostate cancer clinical trial data, epidemiologic data, and the Centers for Disease Control and Prevention Social Vulnerability Index. On analysis of 1,575 counties in the United States with available data, increasing SVI was associated with an increase in prostate cancer mortality (+17.88, 95% CI 14.16-21.61, p < .001), lower odds of having any trial (OR 0.14, 95% CI 0.09-0.23, p < .001), and fewer population-adjusted trials (IRR 0.27, 95% CI 0.19-0.40, P < .001). Identifying communities experiencing adverse social determinants of health for expansion of clinical trial opportunities and mitigation of barriers may be an impactful strategy towards improving equity in clinical trials and cancer care.

© The Author(s) 2025. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.