Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exists among Black men in this country. This primary objective of this systematic review is to describe the reported disparities in screening, diagnostics and treatments as well as efforts to alleviate these disparities though community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, sub-analyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal access care environments have shown similar outcomes. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. The Oncologist 2021;9999:• • Implications for Practice: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher PSA, and other adverse factors, but outcomes can be attenuated in trials or in equal access care environments. Recent data has shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities. BACKGROUND Despite notable progress over the years, prostate cancer remains the leading cancer among men in the United States, with 191,000 cases and 33,000 deaths anticipated in 2020 1. Advances in screening rates, genomic testing, imaging, and treatment have led to an almost 98% five-year survival among affected men 2. Black men, however, have traditionally had higher incidence and decreased rates of survival in prostate cancer for all stages. Statistically, 1 in 9 men overall and 1 in 7 Black men will be affected 3. Moreover, Black men are more likely to be diagnosed at an earlier age, have advanced disease at that time of diagnosis and have significantly elevated PSA levels compared to White men 3-6. They also have a higher risk of regional and metastatic disease at presentation 7,8. Several factors could possibly account for this higher relative incidence and poorer outcomes for Black men with prostate cancer. Patients with lower socioeconomic status and less education have been shown to have worse overall survival from prostate and other ...

BACKGROUND: Therapeutic misconception (TM) refers to research subjects' failure to distinguish the goals of clinical research from standard personal care. TM has traditionally been determined by questioning the patient about the research study's purpose. Recent research, however, has questioned whether TM is as prevalent as reported due to discrepancies between patient/researcher interpretations of TM questions. The authors have created an interview tool receptive to these advancements to more accurately determine the prevalence of TM. METHODS: Patients were questioned about the trial's purpose as follows: 1) "Is the trial mostly intending to help research and gain knowledge?," 2) "Is it mostly intending to help you as a person?," or 3) "Don't know." Participants were then asked what they thought this question was asking: A) "What my own intentions are for participating," B) "What the official purpose of the research study is," or C) "Not sure." A patient exhibited TM by answering that the official trial purpose was to help him or her. RESULTS: Patients (n = 98) had a mean age of 60 years, were mostly White (64%), had a combined family annual income ≥$60,000 (61%), and 49% had a college degree. Twelve of 98 patients (12%) definitely exhibited TM. This was much lower than the author's original finding of 68% in a similar cohort. Twenty-four of 98 patients (24.5%) were unclear about what one or both questions were asking and could not be categorized. CONCLUSIONS: Previously, a patient was thought to have TM if they answered that the purpose of the trial was to benefit to him or her. An additional query about how patients interpreted that question revealed only 12% definitely had TM.

Background. The use of molecular testing in oncology is rapidly expanding. The aim of this study is to determine how oncologists describe molecular testing and whether patients understand the terminology being used. Materials and Methods. Sixty conversations between oncologists and patients about molecular testing were observed and technical terms used were noted by the researcher. Patients were interviewed post-conversation to assess their understanding of the noted technical terms. A patient understanding score was calculated for each participant. Comparisons of the terms were conducted using chisquare tests, Fisher's exact tests, or ANOVA where appropriate.Results. Sixty-one unique technical terms were used by oncologists, to describe 7 topics. 'Mutation' was a challenging term for patients to understand with 48.8% (21/43 mentions) of participants correctly defining the term. 'Genetic testing' was understood a little over half the time (53.3%; 8/15). 'Gene' was well understood (66.7%; 26/39) as was 'DNA' (80%; 12/15). There was no correlation between the terms being defined by the oncologist in the conversation, and the likelihood of the patient providing a correct definition. White participants were significantly more likely to understand both 'mutation' and 'genetic testing' than nonwhite participants. 42%(n=25) of participants had an understanding score below 50%, and a higher family income was significantly correlated with a higher score. Conclusion.Our results show that oncologists use variable terminology to describe molecular testing, which is often not understood. Since oncologists' defining the terms did not correlate with understanding, it is imperative to develop new, improved methods to explain molecular testing. The Oncologist 2021;9999:• • Implications for Practice: The use of molecular testing is expanding in oncology, yet little is known about how effectively clinicians are communicating information about molecular testing and whether patients understand the terminology used. Our results indicate that patients do not understand some of the terminology used by their clinicians, and that clinicians tend to use highly variable terminology to describe molecular testing. These results highlight the need to develop and implement effective methods to explain molecular testing terminology to patients to ensure that patients have the tools to make autonomous and informed decisions about their treatment.

No abstract