Racial Differences in the Diagnosis and Treatment of Prostate Cancer

Abstract

Disparities between African American and Caucasian men in prostate cancer (PCa) diagnosis and treatment in the United States have been well established, with significant racial disparities documented at all stages of PCa management, from differences in the type of treatment offered to progression-free survival or death. These disparities appear to be complex in nature, involving biological determinants as well as socioeconomic and cultural aspects. We present a review of the literature on racial disparities in the diagnosis of PCa, treatment, survival, and genetic susceptibility. Significant differences were found among African Americans and whites in the incidence and mortality rates; namely, African Americans are diagnosed with PCa at younger ages than whites and usually with more advanced stages of the disease, and also undergo prostate-specific antigen testing less frequently. However, the determinants of the high rate of incidence and aggressiveness of PCa in African Americans remain unresolved. This pattern can be attributed to socioeconomic status, detection occurring at advanced stages of the disease, biological aggressiveness, family history, and differences in genetic susceptibility. Another risk factor for PCa is obesity. We found many discrepancies regarding treatment, including a tendency for more African American patients to be in watchful waiting than whites. Many factors are responsible for the higher incidence and mortality rates in African Americans. Better screening, improved access to health insurance and clinics, and more homogeneous forms of treatment will contribute to the reduction of disparities between African Americans and white men in PCa incidence and mortality.

Cancer survival among Alaska Native people

“…A recent analysis of colorectal cancer cases showed no difference in the stage at diagnosis for colorectal cancers; however, this may not be true for all cancer sites. Second, there could be differences in the biological aggressiveness of tumors between AN people and US whites, as has been suggested for black men and prostate cancer . Whether this is true for these cancer sites among AN people is unknown.…”

“…Second, there could be differences in the biological aggressiveness of tumors between AN people and US whites, as has been suggested for black men and prostate cancer. 33,34 Whether this is true for these cancer sites among AN people is unknown. Third, cancer treatments may not be as effective among AN people as among their US white counterparts.…”

Physical activity and quality of life in African American cancer survivors: The Detroit Research on Cancer Survivors study

“…Even though cancer mortality rates have declined faster among African Americans than non‐Hispanic whites, they continue to have a disproportionately higher incidence of and poorer survival with most cancers in comparison with other racial and ethnic groups in the United States . The reasons for the observed racial disparity in cancer mortality have been attributed in part to differential access to and utilization of health care services, including lower screening rates, lower uptake of treatment, and less frequent postdiagnosis surveillance . Other explanations include the presence of comorbid conditions and inherent differences in tumor biology among African American diagnosed with certain cancers associated with a more aggressive disease course and a greater risk of progression .…”

Exercise and prostate cancer: From basic science to clinical applications

“…The only well‐established risk factors for PCa are older age, black race/ethnicity, and a family history of the disease . African American men are nearly 1.6 times more likely to be diagnosed with PCa than Caucasian American men and 2.4 times more likely to die from the disease .…”