Racial and ethnic disparities in metabolic syndrome care among prostate cancer patients on androgen deprivation therapy.

INTRODUCTION: Androgen deprivation therapy (ADT) is used for prostate cancer (PCa) but increases metabolic syndrome risk factors (MSRF). Guidelines recommend MSRF screening and treatment during ADT; however, adherence and disparities remain unclear. We evaluated racial and ethnic differences in MSRF screening and treatment rates among PCa patients initiating ADT. METHODS: We included 803 PCa patients initiating ADT at the University of New Mexico Comprehensive Cancer Center, 2010-2021. Guideline-concordant screening, based on the 2010 AHA/ACS/AUA scientific advisory committee, required primary care or completion of blood pressure, glucose, and lipid testing, with treatment continuation or initiation when indicated within six months of ADT initiation. Logistic regression assessed predictors of screening. RESULTS: Only 23.5% of patients received guideline-concordant screening. Rates were 26.8% (122/455) among NHW, 17.8% (43/242) Hispanic, 30.6% (15/49) African American, 14.6% (6/41) AI/AN/HN, and 18.8% (3/16) Asian patients. Compared with NHW patients, adjusted odds (aOR) were lower among Hispanic (aOR 0.40; 95% CI, 0.20-0.60; p = 0.0001), AI/AN/HN (aOR 0.20; 95% CI, 0.07-0.70; p = 0.007), and Asian patients (aOR 0.20; 95% CI, 0.04-0.90; p = 0.04). Guideline-concordant treatment occurred in 76.9% of eligible patients. Baseline dyslipidemia (aOR 3.10; 95% CI, 2.00-4.70; p < 0.0001) and oncologist experience >20 years versus <10 years (aOR 2.90; 95% CI, 1.40-6.30; p = 0.006) were associated with higher screening odds. DISCUSSION: MSRF screening was suboptimal, with significant racial and ethnic disparities. Estimates for AI/AN/HN and Asian subgroups warrant caution because of small sample sizes. Continuous provider education, standardized protocols, and improved access may reduce cardiometabolic risks and inequities.