Racial disparities in prostate cancer treatment – how can we better address them?

At major oncology congresses across the U.S., the latest in prostate cancer research is almost always a part of the conversation. Yet, despite the progress seen in prostate cancer detection and care over the years, Black men are relatively more likely to receive substandard care for their prostate cancer, which we see in the ever-prevalent racial disparities that broadly impact this community.¹

Historically, Black men have been the most negatively affected by racial disparities in prostate cancer, and these continue to exist despite the strides in research, testing, detection, and treatment over the past several decades. Not only is the disease more commonly developed and more deadly in Black men than white men, but Black men are also more likely to develop prostate cancer at a younger age and progress to an advanced stage prior to ever being diagnosed or treated.^1,2

Though the existence of diagnosis and outcomes gaps between racial groups are frequently discussed, the question remains – how can physicians better address them?

“Several groups are working to understand whether the disparities among Black men are driven primarily by access, including looking at systems like the Veterans Health Administration, where access is more equitable across racial groups,” said Tanya Dorff, M.D., Section Chief of the Genitourinary Disease Program and Associate Professor of the Department of Medical Oncology & Therapeutics Research, City of Hope. “What they find is that access is clearly a large issue, and that equal access is a major determinant of racial equity when it comes to treatment of men diagnosed with prostate cancer.”³

New research suggests that, when access issues are not a factor, outcomes for Black men can and do improve. A study evaluating data from the Veterans Health Administration found that African American men diagnosed with prostate cancer did not appear to experience worse outcomes compared with non-Hispanic white men.³

Healthcare disparities can also exist within clinical practice. While treatments like novel hormone therapies (NHTs), androgen deprivation therapy (ADT), chemotherapy and radiation are often recommended in relevant guidelines, research has shown that not all the eligible patients are currently receiving this care.⁴

When it comes to Black men, this gap in treatment related decisions may be even more pronounced. In one U.S. study evaluating treatment patterns across race/ethnicity groups based on data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER) database for 8,828 prostate cancer patients, researchers found non-Hispanic Black men initially diagnosed with advanced stage prostate cancer were significantly less likely to undergo any treatment for their disease compared with non-Hispanic white men.⁵

“I think physicians really need to study themselves — am I offering the same treatments options for all patients and am I consistently following evidence based clinical guidelines when making treatment decisions,” continued Dr. Dorff. “Awareness is really the first step, including awareness around our own preferences and prejudices. While insurance coverage may impact practice patterns, research into physician and patient-based obstacles to guidelines-based care is needed to help close the gap.”

For an overview of guidelines for certain forms of advanced prostate cancer, visit Treatment considerations for mCSPC and CRPC, a new online resource launched by Pfizer and Astellas.

References

¹American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta, GA: American Cancer Society, 2019-2021.

²American Cancer Society. Prostate cancer risk factors (06-09-2020). https://www.cancer.org/cancer/prostate- cancer/causes-risks-prevention/risk-factors.html. Accessed 1-14-2022.

³Riviere P, Luterstein E, Kumar A, Vitzthum LK, Deka R, Sarkar RR, Bryant AK, Bruggeman A, Einck JP, Murphy JD, Martínez ME, Rose BS. Survival of African American and non-Hispanic white men with prostate cancer in an equal- access health care system. Cancer. 2020 Apr 15;126(8):1683-1690. doi: 10.1002/cncr.32666. Epub 2020 Jan 27. PMID: 31984482.

⁴Data on file. Northbrook, IL: Astellas Inc.

⁵Beebe-Dimmer JL, et al. Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER-Medicare investigation. Cancer medicine, 8(6), 3325–3335. https://doi.org/10.1002/cam4.2092.