Disparities in prostate cancer screening, diagnoses, management, and outcomes between Indigenous and non‐Indigenous men in a universal health care system

Abstract

BackgroundIndigenous Peoples have higher morbidity rates and lower life expectancies than non‐Indigenous Canadians. Identification of disparities between Indigenous and non‐Indigenous men regarding prostate cancer (PCa) screening, diagnoses, management, and outcomes was sought.MethodsAn observational cohort of men diagnosed with PCa between June 2014 and October 2022 was studied. Men were prospectively enrolled in the province‐wide Alberta Prostate Cancer Research Initiative. The primary outcomes were tumor characteristics (stage, grade, and prostate‐specific antigen [PSA]) at diagnosis. Secondary outcomes were PSA testing rates, time from diagnosis to treatment, treatment modality, and metastasis‐free, cancer‐specific, and overall survivals.ResultsExamination of 1,444,974 men for whom aggregate PSA testing data were available was performed. Men in Indigenous communities were less likely to have PSA testing performed than men outside of Indigenous communities (32 vs. 46 PSA tests per 100 men [aged 50–70 years] within 1 year; p < .001). Among 6049 men diagnosed with PCa, Indigenous men had higher risk disease characteristics: a higher proportion of Indigenous men had PSA ≥ 10 ng/mL (48% vs. 30%; p < .01), TNM stage ≥ T2 (65% vs. 47%; p < .01), and Gleason grade group ≥ 2 (79% vs. 64%; p < .01) compared to non‐Indigenous men. With a median follow‐up of 40 months (interquartile range, 25–65 months), Indigenous men were at higher risk of developing PCa metastases (hazard ratio, 2.3; 95% CI, 1.2–4.2; p < .01) than non‐Indigenous men.ConclusionsDespite receiving care in a universal health care system, Indigenous men were less likely to receive PSA testing and more likely to be diagnosed with aggressive tumors and develop PCa metastases than non‐Indigenous men.

A mobile health application for prostate cancer antigen dosage: is it time to say goodbye to classic screening methods?

“…The authors showed that Indigenous men were less likely to have PSA testing performed in contrast to non-Indigenous community at all potential timeframes for PSA screening (Kiciak et al, 2023). Moreover, they enlightened that within Indigenous men community, the PSA was ≥10 ng/mL at diagnosis, suggesting the limited access of this community to PSA screening campaign (Kiciak et al, 2023). Finally, Creta et al examined the incorporation of mHealth into the clinical management of patients experienced benign condition such as lower urinary tract symptoms (LUTS) (Creta et al, 2023).…”

“…For instance, Arawaka et al conducted a randomized clinical trial assessing the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms among 734 pregnant women living in Yokohama (Arakawa et al, 2023). Furthermore, Kiciak et al studied the PSA screening rates between Indigenous and non-Indigenous men collected within the Alberta Prostate Cancer Research Initiative (Kiciak et al, 2023). The authors showed that Indigenous men were less likely to have PSA testing performed in contrast to non-Indigenous community at all potential timeframes for PSA screening (Kiciak et al, 2023).…”

“…Furthermore, Kiciak et al studied the PSA screening rates between Indigenous and non-Indigenous men collected within the Alberta Prostate Cancer Research Initiative (Kiciak et al, 2023). The authors showed that Indigenous men were less likely to have PSA testing performed in contrast to non-Indigenous community at all potential timeframes for PSA screening (Kiciak et al, 2023). Moreover, they enlightened that within Indigenous men community, the PSA was ≥10 ng/mL at diagnosis, suggesting the limited access of this community to PSA screening campaign (Kiciak et al, 2023).…”

Preventive care recommendations to promote health equity

“…We also support calls for more research on ways to address specific inequities not addressed by this guidance, such as prostate cancer in Indigenous and Black males. 244 , 245 …”

Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé

“…Nous nous prononçons également en faveur de recherches plus approfondies sur la façon de lutter contre d’autres iniquités que le présent document n’aborde pas, par exemple, celle qui touche le cancer de la prostate chez les hommes autochtones et de race noire 246 , 247 .…”