Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer

Abstract

Background Prostate cancer (PCa) remains the most common malignancy and the second leading cause of cancer death among men in the United States. PCa exhibits the most striking racial disparity, as African American men are at 1.4 times higher risk of being diagnosed, and two to three times higher risk of dying of PCa, compared to Caucasian men. The etiology of the disparity has not been clearly elucidated. The objective of this paper is to critically review the literature and summarize the most prominent PCa racial disparities accompanied by proposed explanations. Methods The present literature on disparities at presentation, diagnosis, treatment and survival of African American men affected by PCa was systematically reviewed. Original research as well as relevant review articles were included. Results African American men recurrently present with more advanced disease than Caucasian men, are administered different treatment regimens than Caucasian men, and have shorter progression-free survival following treatment. In addition, African American men report more treatment related side-effects that translates to the diminished quality of life. Conclusions PCa racial disparity exists at stages of presentation, diagnosis, treatment regimens and subsequent survival, and the quality of life. The disparities are complex in involving biological, socio-economic and socio-cultural determinants. These mounting results highlight an urgent need for future clinical, scientific and socio-cultural research involving transdisciplinary teams to elucidate the causes for PCa racial disparities.

Variation in prostate cancer treatment associated with population density of the county of residence

“…Other studies have established differences in prostate cancer treatment modality between race/ethnicity groups. 9,[11][12][13]21 The current study also found differences in treatment associated with race/ ethnicity, even adjusting for other clinical and sociodemographic factors. Comparing patients residing in different population-dense counties, we found variation in treatment despite adjustment for case mix in terms of prostate cancer disease characteristics.…”

“…[5][6][7] In addition, treatment decisions vary with race/ethnicity, income and marital status. [8][9][10] Few studies have examined whether treatment decisions for localized prostate cancer differ by urban, suburban or rural geographical region. Some investigators have found no difference in the proportion receiving surgery and radiation between urban and rural men, while others have found a higher likelihood of radiation in men residing in rural areas.…”

National trends and determinants of proton therapy use for prostate cancer: A National Cancer Data Base study

“…[17][18][19] It is difficult to explain why Black, Hispanic, and other minority patients are less likely to receive proton therapy for prostate cancer despite these robust adjustments. One could argue patient preference plays a large role, 20 however the patients in our study all received radiation therapy and so it is highly unlikely that minority patients were overwhelmingly less likely to prefer the more resource limited proton therapy vs other forms of radiation therapy.…”

Prostate cancer in the African-Caribbean community

“…A systematic review of these disparities revealed that African-American men present at a younger age and also have higher-risk disease and higher tumour volumes. 27 Similarly the management of low-risk disease in African-Caribbean men has also been scrutinised. There is increasing concern regarding the role of active surveillance in low-risk prostate cancer in African-Caribbean men.…”