Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Abstract

Despite notable screening, diagnostic, and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. Although commonly discussed in the context of men of African descent, disparities also exist based on socioeconomic level, education level, and geographic location. The factors in these disparities span systemic access issues affecting availability of care, provider awareness, and personal patient views and mistrust. In this review, we will discuss common themes that patients have noted as impediments to care. We will review how equitable access to care has helped improve outcomes among many different groups of patients, including those with local disease and those with metastatic castration-resistant prostate cancer. Even with more advanced presentation, challenges with recommended screening, and lower rates of genomic testing and trial inclusion, Black populations have benefited greatly from various modalities of therapy, achieving comparable and at times superior outcomes with certain types of immunotherapy, chemotherapy, androgen receptor–based inhibitors, and radiopharmaceuticals in advanced disease. We will also briefly discuss access to genomic testing and differences in patterns of gene expression among Black patients and other groups that are traditionally underrepresented in trials and genomic cohort studies. We propose several strategies on behalf of providers and institutions to help promote more equitable care access environments and continued decreases in prostate cancer disparities across many subgroups.

Understanding the Role of Urology Practice Organization and Racial Composition in Prostate Cancer Treatment Disparities

“…Although treatment disparities could be improving in more recent data, racial disparities in prostate cancer still exist as evidenced by robust ongoing debate on how to mitigate them. 37,38 A final limitation is inclusion of men age 65 years and older. Despite this, more than half (57%) of patients diagnosed with prostate cancer are 65 years and older, indicating that our findings are reflective of most prostate cancer care in the United States.…”

18F‐sodium fluoride positron emission tomography quantitation of bone metastases in African American and non‐African American men with metastatic prostate cancer

“…25 AA also have less access to molecular imaging, 20 but fortunately respond as well or better to treatment for metastatic disease if they receive the same treatment as other racial groups. 9 In this exploratory study, we examined the distribution of bone metastases in AA and non-AA men with a low volume of prostate cancer newly metastatic to bone to better characterize the distribution of T A B L E 4 Summary of HU mean of healthy bone. F I G U R E 2 Average number of metastatic lesions in each of the predefined skeletal regions for African-American (AA) and non-AA patients.…”

“…[5][6][7][8] In spite of this, AA men with metastatic prostate cancer do as well if not better than other races if they receive the same treatment. 9 For example, higher overall survival (OS) rates were reported for AA men who received: docetaxel for metastatic castration-resistant prostate cancer (mCRPC), 10 abiraterone in first-line mCRPC, 11 and all treatments combined (at a public hospital with equal access to care in East London, UK). 12 Halabi et al 13 observed that various metastatic sites were each associated with specific OS in patients with mCRPC.…”

Racial/Ethnic Differences in Health-Related Quality of Life Among Gay and Bisexual Prostate Cancer Survivors

“…Participants were excluded from analysis if they were missing any SF-12 or EPIC domain or subdomain scores (N=2) or if they refused to answer what their race or ethnicity was (N=1).The multivariable models included variables that had a statistically significant (p ≤ 0.05) association with ethnoracial groups. Because cancer severity may lie on the causal pathway between race/ethnicity and HRQOL ( 16 , 27 , 29 , 31 , 39 , 68 , 69 ) these measures (type of prostate cancer treatment, Gleason score, and count of systemic prostate cancer therapies) were not included in any models. Mean differences were considered to be statistically significant at p < 0.05.…”